Healthcare Provider Details

I. General information

NPI: 1851400444
Provider Name (Legal Business Name): DARVIS QUINN GALLAHER PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 OLD HIGHWAY 64
BOLIVAR TN
38008-3587
US

IV. Provider business mailing address

119 AFTON DR
CORINTH MS
38834-8635
US

V. Phone/Fax

Practice location:
  • Phone: 731-658-6113
  • Fax: 731-658-6165
Mailing address:
  • Phone: 731-658-6113
  • Fax: 731-658-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP 1843
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: