Provider Demographics
NPI:1821848292
Name:GALLOWAY, CRAIG ANTHONY JR
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:GALLOWAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 1/2 4TH ST REAR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4611
Mailing Address - Country:US
Mailing Address - Phone:740-961-7638
Mailing Address - Fax:
Practice Address - Street 1:1302 1/2 4TH ST REAR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4611
Practice Address - Country:US
Practice Address - Phone:740-961-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant