Provider Demographics
NPI:1336610849
Name:GALLOWAY, DANA A (MA, MSM)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MA, MSM
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:E
Other - Last Name:ANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MSM
Mailing Address - Street 1:42442 BLYTH AVE
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-5498
Mailing Address - Country:US
Mailing Address - Phone:985-377-3674
Mailing Address - Fax:
Practice Address - Street 1:PHYSICIANS HEALTHCARE ORGANIZATION
Practice Address - Street 2:6659 SULLIVAN RD
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739
Practice Address - Country:US
Practice Address - Phone:225-261-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health