Organization
2020ATLANTA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GIBSON OD (PRESIDENT)
(919) 880-6066
Entity
Organization
Contact information
Practice address
20 10TH ST NW UNIT 1101, ATLANTA, GA 30309-3868
(617) 356-9117
Mailing address
20 10TH ST NW UNIT 1101, ATLANTA, GA 30309-3868
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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