Provider Demographics
NPI:1861038333
Name:GALLOWAY, LATANYA SMOOT
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:SMOOT
Last Name:GALLOWAY
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 1:1008 N AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8582
Mailing Address - Country:US
Mailing Address - Phone:601-985-7401
Mailing Address - Fax:
Practice Address - Street 1:1008 N AZALEA DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8582
Practice Address - Country:US
Practice Address - Phone:601-985-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)