MEDICARE: MRS. AVERY POPE GALLO 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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1912756784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AVERY POPE GALLO PA-C

Provider Business Mailing Address
First Line	:	20036 ZION AVENUE, SUITE 100
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031
Country	:	US
Telephone Number	:	910-308-1059
Fax Number	:

Provider Business Practice Location Address
First Line	:	20036 ZION AVENUE, SUITE 100
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031
Country	:	US
Telephone Number	:	910-308-1059
Fax Number	:

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

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	12/08/2025

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