Individual
SAMUEL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
791 OAK ST, HAPEVILLE, GA 30354-1748
(404) 601-2000
(404) 559-0806
Mailing address
791 OAK STREET, HAPEVILLE, GA 30354
(404) 601-2000
(404) 559-0806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2675
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2675
GEOGIA PHYSICIAN ASSISTANT LICENSE
GA
Enumeration date
10/28/2010
Last updated
10/28/2010
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