Provider Demographics
NPI:1134224363
Name:GALLOWAY, TREPHINA H (DO)
Entity type:Individual
Prefix:
First Name:TREPHINA
Middle Name:H
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PARKWAY BLDG C
Mailing Address - Street 2:SUITE 465
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2119
Mailing Address - Country:US
Mailing Address - Phone:678-888-4460
Mailing Address - Fax:678-888-5533
Practice Address - Street 1:3400 OLD MILTON PARKWAY BLDG C
Practice Address - Street 2:SUITE 465
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3000
Practice Address - Country:US
Practice Address - Phone:678-888-4460
Practice Address - Fax:678-888-5533
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050800207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI16486Medicare UPIN
GA511I070014Medicare PIN