Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 006460 | GA |
NPI | 1336357250 |
---|---|
Provider Name | Dr. Clayton Gibson III |
First Address | Atlanta, GA 30318-6901 |
Second Address | Atlanta, GA 30318-6901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 23/09/2014 |