Individual
HETTIE SUSIE GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
661 MADISON AVE, SUITE A, MEMPHIS, TN 38103-3307
(901) 527-2417
(901) 522-9646
Mailing address
661 MADISON AVE, SUITE A, MEMPHIS, TN 38103-3307
(901) 527-2417
(901) 522-9646
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13743
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3019528
—
TN
Enumeration date
05/10/2006
Last updated
12/09/2009
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