Individual
DR. KATHLEEN K GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6131 S NORCROSS TUCKER RD, STE 700, NORCROSS, GA 30093-5536
(678) 205-1959
(678) 205-2092
Mailing address
5019 KENDALL STA NW, ACWORTH, GA 30102-7962
(770) 974-4314
(678) 421-9702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
026530
GA
208000000X
Pediatrics Physician
Primary
26530
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000639834Z
—
GA
Enumeration date
07/18/2006
Last updated
06/13/2012
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