Provider Demographics
NPI:1184757049
Name:GAILLARD, DENOTRA (FNP)
Entity type:Individual
Prefix:
First Name:DENOTRA
Middle Name:
Last Name:GAILLARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4399 REESEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2765
Mailing Address - Country:US
Mailing Address - Phone:706-569-8144
Mailing Address - Fax:706-568-2122
Practice Address - Street 1:633 19TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1551
Practice Address - Country:US
Practice Address - Phone:706-660-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN0660447163WC1500X
GARN060447163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory