Healthcare Provider Details

I. General information

NPI: 1184757049
Provider Name (Legal Business Name): DENOTRA GAILLARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 19TH ST SUITE B
COLUMBUS GA
31901-1551
US

IV. Provider business mailing address

4399 REESEWOOD CT
COLUMBUS GA
31907-2765
US

V. Phone/Fax

Practice location:
  • Phone: 706-660-1914
  • Fax:
Mailing address:
  • Phone: 706-569-8144
  • Fax: 706-568-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0660447
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN060447
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: