Organization
PRISTINE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANTHONY GIBSON M.D. (OWNER)
(404) 580-7642
Entity
Organization
Contact information
Practice address
5000 SERENITY POINT LN, VILLA RICA, GA 30180-6963
(404) 580-7642
Mailing address
5000 SERENITY POINT LN, VILLA RICA, GA 30180-6963
(404) 580-7642
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
057975
GA
Other
Enumeration date
06/24/2013
Last updated
06/24/2013
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