Provider Demographics
NPI:1558433086
Name:GALLAWAY, DOROTHY K (CFNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:K
Last Name:GALLAWAY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 PATTERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1652
Mailing Address - Country:US
Mailing Address - Phone:404-378-7698
Mailing Address - Fax:
Practice Address - Street 1:1350 BOULEVARD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-3016
Practice Address - Country:US
Practice Address - Phone:404-635-1300
Practice Address - Fax:404-635-1320
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN058116 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00630649DMedicaid
GA00630649DMedicaid
GAS00370Medicare UPIN