Provider Demographics
NPI:1902165806
Name:GALIS, ANTHONY M (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:GALIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6047
Mailing Address - Country:US
Mailing Address - Phone:706-850-2000
Mailing Address - Fax:
Practice Address - Street 1:2080 PRINCE AVENUE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2917
Practice Address - Country:US
Practice Address - Phone:706-850-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14337171100000X
GA000308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist