Individual
JERRY L GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4474
(615) 234-3774
Mailing address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4474
(615) 234-3774
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
01045587
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
15265
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
15291
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3040447
—
TN
01
—
4110190
BLUE CROSS
TN
01
—
50010952
PASSPORT
KS
05
—
64774821
—
KY
Enumeration date
09/25/2006
Last updated
07/08/2007
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