Provider Demographics
NPI:1487610259
Name:GALAWAY, JENNIFER LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:GALAWAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 OAKMONT CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6076
Mailing Address - Country:US
Mailing Address - Phone:336-543-8874
Mailing Address - Fax:281-605-5579
Practice Address - Street 1:2001 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-375-6990
Practice Address - Fax:336-375-0361
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC648213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159199203Medicaid
TX159199205Medicaid
TX159199204Medicaid
TXP00450861OtherRAIL RD. MEDICARE
TXP00450861OtherRAIL RD. MEDICARE
TX8J7067Medicare PIN
TX8J7064Medicare PIN
TXU95922Medicare UPIN
TX8F3094Medicare PIN
TX8J7065Medicare PIN