Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | GA0005800 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | GA0005800 | GA |
NPI | 1801018858 |
---|---|
Provider Name | Dr. Michael Gallo |
First Address | Dunwoody, GA 30038 |
Second Address | Norcross, GA 30092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |