Individual provider Active NPI

Vijaya Lakshmi Galic, M.D.

  • Gynecologic Oncology Physician
  • Gainesville, GA
National Provider Identifier
1801093513
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
94391 Issued in GA
Practice address
743 Spring St NE
Gainesville, GA 30501-3715
Phone
(770) 219-9000
NPI assigned
Jun 27, 2007
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X 94391 GA Primary
Gynecologic Oncology Physician 207VX0201X 2015031720 MO
Gynecologic Oncology Physician 207VX0201X 74899-20 WI
Gynecologic Oncology Physician 207VX0201X ME143239 FL
Gynecologic Oncology Physician 207VX0201X 73374 MN
Gynecologic Oncology Physician 207VX0201X MD60149499 WA
Obstetrics & Gynecology Physician 207V00000X MD60149499 WA
Gynecologic Oncology Physician 207VX0201X 260966 NY

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501-3715

Mailing address

PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8430

Other practice location 1

1003 S 5th St
4th Floor
Tacoma, WA 98405-4210
Phone (253) 403-1677

Other practice location 2

1400 NW 12th Ave
Miami, FL 33136-1003
Phone (305) 243-4000

Other practice location 3

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3282

Other practice location 4

699 Church St NE Ste 235
Marietta, GA 30060-1132
Phone (770) 792-6262

Other names 1

  • Vijaya L Ayengar Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vgalic520543@directwellstar.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI, PA, GA, TN5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20170106000854 TX Practitioner - Gynecological OncologyPractitioner - Obstetrics/Gynecology 7315180825 Reassigns benefits to 2 organizations
I20210415000146 WI Practitioner - Gynecological Oncology 7315180825 Reassigns benefits to 1 organization
I20220604000032 PA Practitioner - Gynecological Oncology 7315180825 Reassigns benefits to 1 organization
I20230526000256 GA Practitioner - Obstetrics/Gynecology 7315180825 Reassigns benefits to 1 organization
I20230724000685 TN Practitioner - Obstetrics/Gynecology 7315180825 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60149499WAMDObstetrics & Gynecology Physician
94391GAMDGynecologic Oncology Physician
73374MNMDGynecologic Oncology Physician
260966NYMDGynecologic Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Women's Care of Wisconsin S.C. Obstetrics & Gynecology CurrentSince May 3, 2021 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jul 1, 2023 Accepting new patients
The Milton S. Hershey Medical Center Physicians Group Gynecologic Oncology CurrentSince Jun 1, 2022 Accepting new patients
Theda Clark OB Hospitalists SC Obstetrics & Gynecology CurrentSince Sep 5, 2023 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Jun 1, 2022 Accepting new patients
Texas Tech University Health Sciences Center El Paso CurrentSince Dec 2, 2016 Accepting new patients
Texas Tech University Health Sciences Center El Paso CurrentSince Dec 2, 2016 Accepting new patients
Texas Tech University Health Sciences Center El Paso Current Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Wellmont Medical Associates Inc Obstetrics & Gynecology CurrentSince Jul 1, 2023 Accepting new patients
Women's Cancer and Surgical Care PC Gynecologic Oncology CurrentSince Sep 1, 2020 Accepting new patients
Northeast Georgia Physicians Group Inc CurrentSince May 30, 2024 Accepting new patients
DRH Medical Group Past Accepting new patients

Locations

1315 Jesse Jewell Pkwy NE
Ste 110
Gainesville, GA 30501
Phone (770) 219-0023

597 S Enota Dr NE
Gainesville, GA 30501
Phone (770) 219-8275

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-5915

4610 Jefferson Ln NE
Albuquerque, NM 87109
Phone (505) 559-4495

500 University Dr
#4
Hershey, PA 17033
Phone (717) 531-8144

500 University Dr
#410
Hershey, PA 17033
Phone (717) 531-1159

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

2202 N John B Dennis Hwy
Ste 204
Kingsport, TN 37660
Phone (423) 224-3300

4532 N Mesa St
Ste 301
El Paso, TX 79912
Phone (915) 317-5077

4800 Alberta Ave
El Paso, TX 79905
Phone (915) 215-5666

4800 Alberta Ave
#101
El Paso, TX 79905
Phone (915) 215-4478

4801 Alberta Ave
El Paso, TX 79905
Phone (915) 215-5200

3232 N Ballard Rd
Ste 100
Appleton, WI 54911

200 Theda Clark Medical Plz
Ste 130
Neenah, WI 54956

100 County Road B
Ste 4
Shawano, WI 54166

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1801093513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013715",
            "telephone_number": "770-219-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1003 S 5th St",
            "address_2": "4th Floor",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054210",
            "country_code": "US",
            "telephone_number": "253-403-1677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 NW 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331361003",
            "country_code": "US",
            "telephone_number": "305-243-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6500 Excelsior Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554264702",
            "country_code": "US",
            "telephone_number": "952-993-3282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "699 Church St NE Ste 235",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300601132",
            "country_code": "US",
            "telephone_number": "770-792-6262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALIC",
        "first_name": "VIJAYA",
        "middle_name": "LAKSHMI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "GA",
            "license": "94391",
            "primary": true
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "MO",
            "license": "2015031720",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "WI",
            "license": "74899-20",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "FL",
            "license": "ME143239",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "MN",
            "license": "73374",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "WA",
            "license": "MD60149499",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD60149499",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NY",
            "license": "260966",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vgalic520543@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "699 Church St NE Ste 235",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VIJAYA",
            "last_name": "AYENGAR",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.