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Individual

CANDICE GIBSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
857 COLLIER RD NW STE 1, ATLANTA, GA 30318-2544
(404) 419-7760
(404) 351-3977
Mailing address
857 COLLIER RD NW STE 1, ATLANTA, GA 30318-2544
(404) 419-7760
(404) 351-3977

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002025
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PTA002025
STATE LISC NUMBER
GA
Enumeration date
11/03/2006
Last updated
07/16/2016
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