Healthcare Provider Details

I. General information

NPI: 1700393857
Provider Name (Legal Business Name): CORTNEY MORGAN GALLOWAY ACPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORTNEY MORGAN KANIEWSKI

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COTTONWOOD ST
CLAYTON GA
30525-4295
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-7040
  • Fax:
Mailing address:
  • Phone: 770-219-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN-NP239471
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN239471
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberRN239471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: