Provider Demographics
NPI:1336447697
Name:GARLAND, THADDEUS MARKHAM (MD)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:MARKHAM
Last Name:GARLAND
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 1:504 RANKIN ST NE # 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2812
Mailing Address - Country:US
Mailing Address - Phone:703-476-2263
Mailing Address - Fax:620-506-4003
Practice Address - Street 1:12020 SUNRISE VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3429
Practice Address - Country:US
Practice Address - Phone:703-476-2263
Practice Address - Fax:620-506-4003
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012561142084P0804X, 2084P0800X
MDD00748642084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry