Healthcare Provider Details

I. General information

NPI: 1356402127
Provider Name (Legal Business Name): JOSEPH C GALITZIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 HIGHWAY 54
PEACHTREE CITY GA
30269-1451
US

IV. Provider business mailing address

2579 HIGHWAY 54
PEACHTREE CITY GA
30269-1451
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-7807
  • Fax: 770-487-7619
Mailing address:
  • Phone: 770-487-7807
  • Fax: 770-487-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number06331
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: