Basic Information
| Provider Information | |||||||||
| NPI: | 1730128927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3650 J DEWEY GRAY CIR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309091867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639797 | ||||||||
| FaxNumber: | 7068689209 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 J DEWEY GRAY CIR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309091867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639797 | ||||||||
| FaxNumber: | 7068689209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 053226 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 315294700A | 05 | GA | MEDICAID | 199878 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 20NCCNR | 01 | MEDICARE | OTHER |