Individual
DR. MICHELLE J GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5440 WATKINS DR, SUITE B, JACKSON, MS 39206-2034
(601) 364-2726
(601) 364-2731
Mailing address
5440 WATKINS DR, SUITE B, JACKSON, MS 39206-2034
(601) 364-2726
(601) 364-2731
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
15752
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119640
—
MS
Enumeration date
09/13/2005
Last updated
08/12/2011
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