Provider Demographics
NPI:1447803424
Name:GALLOWAY DERMATOLOGIC SURGERY LLC
Entity Type:Organization
Organization Name:GALLOWAY DERMATOLOGIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TREPHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-888-4460
Mailing Address - Street 1:3400 OLD MILTON PKWY STE C465
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4429
Mailing Address - Country:US
Mailing Address - Phone:678-888-4460
Mailing Address - Fax:678-888-5533
Practice Address - Street 1:3400 OLD MILTON PKWY STE C465
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4429
Practice Address - Country:US
Practice Address - Phone:678-888-4460
Practice Address - Fax:678-888-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty