Individual
BRADFORD W GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3200
(404) 851-6325
Mailing address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3200
(404) 851-6325
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
061433
GA
207R00000X
Internal Medicine Physician
R1182
KY
208M00000X
Hospitalist Physician
Primary
061433
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100026740
—
KY
05
—
725131782A
—
GA
Enumeration date
10/10/2007
Last updated
01/19/2017
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