Healthcare Provider Details

I. General information

NPI: 1063618171
Provider Name (Legal Business Name): KEVIN L GALLOWAY, DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 CHADWICK DR 300
JACKSON MS
39204-3463
US

IV. Provider business mailing address

1860 CHADWICK DR 300
JACKSON MS
39204-3463
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-2999
  • Fax: 601-376-2989
Mailing address:
  • Phone: 601-376-2999
  • Fax: 601-376-2989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number16585
License Number StateMS

VIII. Authorized Official

Name: DR. KEVIN L GALLOWAY
Title or Position: MANAGER
Credential: D.O.
Phone: 601-376-2999