Provider Demographics
NPI:1891248092
Name:GALEN MEDICAL GROUP PC
Entity Type:Organization
Organization Name:GALEN MEDICAL GROUP PC
Other - Org Name:GALEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LATHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-308-0521
Mailing Address - Street 1:2200 E 3RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2745
Mailing Address - Country:US
Mailing Address - Phone:423-643-2500
Mailing Address - Fax:423-305-7822
Practice Address - Street 1:2200 E 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2745
Practice Address - Country:US
Practice Address - Phone:423-643-2500
Practice Address - Fax:423-305-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5807332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site