Provider Demographics
NPI:1518994599
Name:GALLAGHER, MERRY (PHD)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22 NORTH COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5368
Mailing Address - Country:US
Mailing Address - Phone:912-764-8321
Mailing Address - Fax:912-764-6790
Practice Address - Street 1:22 NORTH COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5368
Practice Address - Country:US
Practice Address - Phone:912-764-8321
Practice Address - Fax:912-764-6790
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001836103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBFFPMedicare ID - Type Unspecified