Individual
RUSSELL SCOTT GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MR
Contact information
Practice address
1504 HARDEMAN AVE, SUITE B, MACON, GA 31201-1441
(478) 745-3135
Mailing address
117 DOVECOT DR, WARNER ROBINS, GA 31088-8541
(478) 442-4606
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
364491
GA
Other
Enumeration date
10/18/2010
Last updated
10/19/2010
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