Healthcare Provider Details

I. General information

NPI: 1013415066
Provider Name (Legal Business Name): GABRIELLE GALON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 HIGHWAY 34 E STE 1200
NEWNAN GA
30265-6416
US

IV. Provider business mailing address

1640 WYNRIDGE PATH
ALPHARETTA GA
30005-3807
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2121
  • Fax:
Mailing address:
  • Phone: 678-267-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: