Provider Demographics
NPI:1275744450
Name:SAILES, FREDERICK CORTNEY (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CORTNEY
Last Name:SAILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 FOUNTAINS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6380
Mailing Address - Country:US
Mailing Address - Phone:601-981-2525
Mailing Address - Fax:601-981-3152
Practice Address - Street 1:160 FOUNTAINS BLVD STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6380
Practice Address - Country:US
Practice Address - Phone:601-981-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427106208600000X, 2086S0122X
NJ25MA10417400208600000X
AZ595132086S0122X
NY3025772086S0122X
GA072112208200000X
MS206422086S0122X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery