Individual
MICHAEL ANTHONY GIBSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3969 S COBB DR SE, SUITE 201, SMYRNA, GA 30080-6358
(770) 438-2942
Mailing address
5000 SERENITY POINT LN, VILLA RICA, GA 30180-6963
(404) 580-7642
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
057975
GA
208M00000X
Hospitalist Physician
057975
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057975
GA. LICENSE
GA
Enumeration date
07/10/2007
Last updated
03/07/2023
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