Healthcare Provider Details

I. General information

NPI: 1609018001
Provider Name (Legal Business Name): AMANDA GALLOWAY HARTKE MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA HOPE GALLOWAY MD, PHD

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL RIDGE DR
GREENVILLE SC
29605-4267
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-220-7272
  • Fax: 864-241-9211
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36647
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: