Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 02513 | GA |
N | 111NN1001X | Nutrition | 02513 | GA |
NPI | 1528137213 |
---|---|
Provider Name | Patricia A Gibson |
First Address | Atlanta, GA 30306-2427 |
Second Address | Decatur, GA 30030-2444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |