Healthcare Provider Details

I. General information

NPI: 1578638078
Provider Name (Legal Business Name): PITT FAMILY PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 3RD ST
AYDEN NC
28513-7252
US

IV. Provider business mailing address

137 3RD ST
AYDEN NC
28513-7252
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES MADISON GALLOWAY JR.
Title or Position: PRESIDENT
Credential: M. D.
Phone: 252-746-3116