Provider Demographics
NPI:1265733562
Name:DEWEY GALEAS PC
Entity type:Organization
Organization Name:DEWEY GALEAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEAS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-650-1056
Mailing Address - Street 1:6126 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5110
Mailing Address - Country:US
Mailing Address - Phone:706-650-1056
Mailing Address - Fax:706-650-1056
Practice Address - Street 1:6126 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-5110
Practice Address - Country:US
Practice Address - Phone:706-650-1056
Practice Address - Fax:706-650-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095261367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000549282OMedicaid