Individual
JACQUELINE CORINNE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA-CPT-GANOTARY
Contact information
Practice address
6106 INDEPENDENCE WAY, GROVETOWN, GA 30813-1206
(706) 284-2077
Mailing address
6106 INDEPENDENCE WAY, GROVETOWN, GA 30813-1206
(706) 284-2077
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
GA
246RP1900X
Phlebotomy Technician
Primary
GA-11412-75795
GA
246RP1900X
Phlebotomy Technician
N23101917
GA
Other
Enumeration date
05/09/2023
Last updated
01/05/2026
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