Healthcare Provider Details

I. General information

NPI: 1821238460
Provider Name (Legal Business Name): PAMELA JUNE GALLOWAY MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S LAWRENCE ST
MONTGOMERY AL
36104-4788
US

IV. Provider business mailing address

560 S LAWRENCE ST
MONTGOMERY AL
36104-4788
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-7069
  • Fax:
Mailing address:
  • Phone: 334-293-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1453
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: