MEDICARE: MR. DEWEY GENE GALEAS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R095261	GA
2	367500000X	Certified Registered Nurse Anesthetist	R78943	SC
3	367500000X	Certified Registered Nurse Anesthetist	237104	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851392526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEWEY GENE GALEAS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 7867
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-0867
Country	:	US
Telephone Number	:	706-541-2025
Fax Number	:	706-541-2025

Provider Business Practice Location Address
First Line	:	6126 COLUMBIA RD
Second Line	:
City	:	GROVETOWN
State	:	GA
Zip	:	30813-5110
Country	:	US
Telephone Number	:	706-541-2025
Fax Number	:	706-541-2025

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	02/05/2015

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