Provider Demographics
NPI:1699816801
Name:GALLMON, DOROTHY A
Entity Type:Individual
Prefix:MISS
First Name:DOROTHY
Middle Name:A
Last Name:GALLMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 ROCKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7836
Mailing Address - Country:US
Mailing Address - Phone:803-699-7833
Mailing Address - Fax:
Practice Address - Street 1:1135 CARTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2811
Practice Address - Country:US
Practice Address - Phone:803-754-9763
Practice Address - Fax:803-754-6051
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist