Individual
DR. KENNETH BROOKS GIBSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
97 PARKWAY DR, FORT OGLETHORPE, GA 30742-4249
(762) 887-6053
Mailing address
6815 SATYA WAY, CHATTANOOGA, TN 37412-4295
(706) 936-7815
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003618
GA
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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