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Individual
DR. STACEY GIBBONS
Active
Individual
DR. STACEY GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
047596
GA
207L00000X
Anesthesiology Physician
41738
TX
207L00000X
Anesthesiology Physician
Primary
T5325
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000921181E
—
GA
01
—
989896
BCBS
GA
Enumeration date
04/14/2006
Last updated
08/23/2022
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