Provider Demographics
NPI:1922336387
Name:GALLOWAY, JUDY (RD, LD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:RD, LD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 ARMAND DR
Mailing Address - Street 2:APT 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8961
Mailing Address - Country:US
Mailing Address - Phone:901-647-5496
Mailing Address - Fax:
Practice Address - Street 1:7601 SOUTHCREST PARKWAY
Practice Address - Street 2:BAPTIST MEMORIAL HOSPITAL DESOTO
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-772-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0903133V00000X
TN290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered