Individual
THADDEUS B GAILLARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 SOUTHCREST CIRCLE, SUITE 102, SOUTHAVEN, MS 38671
(662) 349-4377
(662) 349-4378
Mailing address
PO BOX 381257, GERMANTOWN, TN 38183-1257
(662) 349-4377
(662) 349-4378
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
11279
MS
207VG0400X
Gynecology Physician
15990
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3018336
—
TN
Enumeration date
01/17/2007
Last updated
02/15/2012
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