Provider Demographics
NPI:1578771515
Name:GALLANT, JOSEPH PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:GALLANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31207-1302
Mailing Address - Country:US
Mailing Address - Phone:478-301-2362
Mailing Address - Fax:478-301-2391
Practice Address - Street 1:655 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2852
Practice Address - Country:US
Practice Address - Phone:478-301-5930
Practice Address - Fax:478-301-5932
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1589106H00000X
GACSW23971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist