MEDICARE: MS. AYANNA SARAN GALLOWAY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	103350	NC

General Provider Information

NPI Number	:	1144291410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AYANNA SARAN GALLOWAY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-0640
Country	:	US
Telephone Number	:	252-536-5440
Fax Number	:	252-536-5444

Provider Business Practice Location Address
First Line	:	250 SMITH CHURCH RD
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-4914
Country	:	US
Telephone Number	:	252-308-9699
Fax Number	:	252-308-6819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	09/21/2021

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