Healthcare Provider Details

I. General information

NPI: 1851392526
Provider Name (Legal Business Name): DEWEY GENE GALEAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 COLUMBIA RD
GROVETOWN GA
30813-5110
US

IV. Provider business mailing address

PO BOX 7867
FORT GORDON GA
30905-0867
US

V. Phone/Fax

Practice location:
  • Phone: 706-541-2025
  • Fax: 706-541-2025
Mailing address:
  • Phone: 706-541-2025
  • Fax: 706-541-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR095261
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR78943
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number237104
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: