Thaddeus B Gaillard Jr., MD

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

11279 Issued in MS

Practice address

401 Southcrest Circle
Suite 102
Southaven, MS 38671

Phone

(662) 349-4377

Fax

(662) 349-4378

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1558413807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 381257",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381831257",
            "telephone_number": "662-349-4377",
            "fax_number": "662-349-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIRCLE",
            "address_2": "SUITE 102",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "38671",
            "telephone_number": "662-349-4377",
            "fax_number": "662-349-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAILLARD",
        "first_name": "THADDEUS",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "TN",
            "license": "15990",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MS",
            "license": "11279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3018336",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kari Freudenberg
• Robin Frey, R.PH.
• Teresa L Fritts, MD
• Frog Services LLC.
• Steven J Fuson, D.D.S, M.S.
• Mary Morgan Galjour, PT, DPT
• Amy H Gallimore, LPC
• Judy Galloway, RD, LD, LDN, CDE
• Vicky J Gamber, ATC
• Gamma Healthcare, Inc

• Gynecology Physician in Southaven, MS
• Providers in Southaven, MS by specialty
• Gynecology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.