Individual
COREY DWAYNE GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1040 PLANTATION BLVD SE, CONYERS, GA 30094-4119
(404) 717-7631
Mailing address
1040 PLANTATION BLVD SE, CONYERS, GA 30094-4119
(404) 717-7631
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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