Healthcare Provider Details

I. General information

NPI: 1295713071
Provider Name (Legal Business Name): JANICE A GALLESHAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY RD NE SUITE 600
SANDY SPRINGS GA
30342-1709
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-4777
  • Fax: 404-256-5515
Mailing address:
  • Phone: 770-495-3396
  • Fax: 770-495-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number033906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: