Provider Demographics
NPI:1053856377
Name:GIBBS-BURTON, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GIBBS-BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SOSEBEE FARM RD UNIT 1426
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-0154
Mailing Address - Country:US
Mailing Address - Phone:678-373-9881
Mailing Address - Fax:
Practice Address - Street 1:516 SOSEBEE FARM RD UNIT 1426
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-0154
Practice Address - Country:US
Practice Address - Phone:678-691-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH12035183500000X
VA0202010312183500000X
DCPH29241835P2201X
GARPH23990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care