Provider Demographics
NPI:1205898426
Name:GALLOWAY, JAMES MADISON JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MADISON
Last Name:GALLOWAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513
Mailing Address - Country:US
Mailing Address - Phone:252-746-3116
Mailing Address - Fax:252-746-2394
Practice Address - Street 1:137 THIRD STREET
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513
Practice Address - Country:US
Practice Address - Phone:252-746-3116
Practice Address - Fax:252-746-2394
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC19342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934387Medicaid
NC201851CMedicare PIN
C80928Medicare UPIN