Individual
MR. DOUGLAS MITCHELL BIBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1300 COGSWELL AVE, PELL CITY, AL 35125-1397
(757) 272-4638
Mailing address
2021 4TH AVE S, PELL CITY, AL 35128-2070
(757) 272-4638
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2001
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
PRIVATE
—
Enumeration date
06/04/2018
Last updated
06/16/2018
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