Dr. Larry Elisha Gibson
Chiropractor Orthopedic Specialist
3333 Northside Dr Suite G
Macon
, Georgia 31210-2588
Dr. Larry Elisha Gibson
Chiropractor Orthopedic Specialist
3333 Northside Dr Suite G
Macon
, Georgia 31210-2588
(478) 477-4415
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About
Features
Specialties
- Chiropractor Orthopedic Specialist
Languages spoken
- English
Location
First Address
- Dr. Larry Elisha Gibson
- 3333 Northside Dr Suite G
- Macon, GA
- Zip : 31210-2588
- Phone : (478) 477-4415
Second Address
- Dr. Larry Elisha Gibson
- 3333 Northside Dr Suite G
- Macon, GA
- Zip : 31210-2588
- Fax : (478) 477-4419
- Phone : (478) 477-4415
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIR001656 | GA |
National Provider Identifier
| NPI | 1093830549 |
|---|---|
| Provider Name | Dr. Larry Elisha Gibson |
| First Address | Macon, GA 31210-2588 |
| Second Address | Macon, GA 31210-2588 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/03/2007 |
| Last Update Date | 27/05/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 202I354140 | MEDICARE PTAN (01) | GA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.