1285777599 NPI number — ARLENE GEORGIA GALLAN PHD INC

Table of content: (NPI 1285777599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285777599 NPI number — ARLENE GEORGIA GALLAN PHD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARLENE GEORGIA GALLAN PHD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285777599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 RANDALL PKWY
Provider Second Line Business Mailing Address:
SUITE 126
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-815-3535
Provider Business Mailing Address Fax Number:
866-293-1180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 RANDALL PKWY
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-2564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-815-3535
Provider Business Practice Location Address Fax Number:
866-293-1180
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALLAN
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
GEORGIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-815-3535

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3018 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6000529 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008371 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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