Provider Demographics
NPI:1407536709
Name:GALLO, DANIEL BRADFORD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRADFORD
Last Name:GALLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 EXPERIMENT STATION RD STE 505
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5327
Mailing Address - Country:US
Mailing Address - Phone:706-310-0324
Mailing Address - Fax:
Practice Address - Street 1:2061 EXPERIMENT STATION RD STE 505
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5327
Practice Address - Country:US
Practice Address - Phone:706-310-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program