Healthcare Provider Details

I. General information

NPI: 1205898426
Provider Name (Legal Business Name): JAMES MADISON GALLOWAY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 THIRD STREET
AYDEN NC
28513
US

IV. Provider business mailing address

PO BOX 427
AYDEN NC
28513
US

V. Phone/Fax

Practice location:
  • Phone: 252-746-3116
  • Fax: 252-746-2394
Mailing address:
  • Phone: 252-746-3116
  • Fax: 252-746-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: