Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 050800 | GA |
NPI | 1134224363 |
---|---|
Provider Name | Trephina H Galloway |
First Address | Atlanta, GA 30327-2119 |
Second Address | Atlanta, GA 30327-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 29/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I16486 | (02) | GA |