Healthcare Provider Details

I. General information

NPI: 1578771515
Provider Name (Legal Business Name): JOSEPH PAUL GALLANT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 1ST ST
MACON GA
31201-2852
US

IV. Provider business mailing address

1327 STADIUM DR
MACON GA
31207-1302
US

V. Phone/Fax

Practice location:
  • Phone: 478-301-5930
  • Fax: 478-301-5932
Mailing address:
  • Phone: 478-301-2362
  • Fax: 478-301-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 1589
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW2397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: