Basic Information
| Provider Information | |||||||||
| NPI: | 1689134843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | ALLYN | ||||||||
| MiddleName: | MORGAN KING | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KING | ||||||||
| OtherFirstName: | ALLYN | ||||||||
| OtherMiddleName: | MORGAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 CORPORATE CENTER DR | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | SCOTT DEPOT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25560 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CORPORATE CENTER DRIVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | SCOTT DEPOT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918870 | ||||||||
| FaxNumber: | 3046911665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2019 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 31379 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.