Provider Demographics
NPI:1902021793
Name:GALLAWAY, STACEY ANA (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANA
Last Name:GALLAWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 HULON LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4841
Mailing Address - Country:US
Mailing Address - Phone:803-755-3337
Mailing Address - Fax:803-955-2225
Practice Address - Street 1:3799 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3750
Practice Address - Country:US
Practice Address - Phone:803-755-3337
Practice Address - Fax:803-955-2225
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC232632083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine