Individual
MR. JERROLD GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2787 N DECATUR RD, DECATUR, GA 30033-5919
(404) 292-0626
Mailing address
152 SPRING ST, JONESBORO, GA 30236-3555
(404) 960-0853
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA001697
GA
224Z00000X
Occupational Therapy Assistant
OTA3164
CA
Other
Enumeration date
02/27/2021
Last updated
02/27/2021
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