Healthcare Provider Details

I. General information

NPI: 1093702326
Provider Name (Legal Business Name): EILEEN M GALLAGHER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MAIN ST SW
HANCEVILLE AL
35077-5476
US

IV. Provider business mailing address

PO BOX 1108
CULLMAN AL
35056-1108
US

V. Phone/Fax

Practice location:
  • Phone: 256-352-4767
  • Fax: 256-352-4797
Mailing address:
  • Phone: 256-737-2882
  • Fax: 256-737-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO285
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: