Individual
DR. VIENNA L. GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4017 HIGHWAY 17 # 200, MURRELLS INLET, SC 29576-5032
(843) 651-4600
Mailing address
PO BOX 691, MURRELLS INLET, SC 29576-0691
(843) 651-4600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
36498
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC3276D652
MEDICARE PTAN
SC
Enumeration date
10/06/2009
Last updated
10/30/2014
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