Individual
DR. LARRY ELISHA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3333 NORTHSIDE DR, SUITE G, MACON, GA 31210-2588
(478) 477-4415
(478) 477-4419
Mailing address
3333 NORTHSIDE DR, SUITE G, MACON, GA 31210-2588
(478) 477-4415
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
CHIR001656
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I354140
MEDICARE PTAN
GA
Enumeration date
03/20/2007
Last updated
05/27/2010
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