Individual
DIXIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
514 LEE ST, JOHNSTON, SC 29832-1131
(803) 275-1755
(803) 275-1785
Mailing address
514 LEE ST, JOHNSTON, SC 29832-1131
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
RN.38408 R
SC
Other
Enumeration date
04/05/2013
Last updated
04/05/2013
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