Healthcare Provider Details

I. General information

NPI: 1033484555
Provider Name (Legal Business Name): JEAN GAILLARD SPAULDING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PRATT ST STE 1500 BOX 3644 FIRST FLOOR
DURHAM NC
27705-3976
US

IV. Provider business mailing address

301 RUSSO VALLEY DR CAMERON POND
CARY NC
27519-8111
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-3326
  • Fax: 909-668-3323
Mailing address:
  • Phone: 919-668-3326
  • Fax: 919-668-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number18382
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: