Healthcare Provider Details

I. General information

NPI: 1902021793
Provider Name (Legal Business Name): STACEY ANA GALLAWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MEDICAL LN
WEST COLUMBIA SC
29169-4817
US

IV. Provider business mailing address

470 HULON LN
WEST COLUMBIA SC
29169-4841
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-2199
  • Fax:
Mailing address:
  • Phone: 803-755-3337
  • Fax: 803-955-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number23263
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: