Provider Demographics
NPI:1033450382
Name:GALLER, ALLYSON BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:BETH
Last Name:GALLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:BETH
Other - Last Name:ERVING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1350 WALTON WAY
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-722-9011
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-722-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08348363A00000X
GA7966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320204601Medicaid
TX320204602OtherCSHCN
TX320204601Medicaid