Provider Demographics
NPI:1063864130
Name:GIBBY, NORMAN MILLER JR (PA)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:MILLER
Last Name:GIBBY
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:775 POPLAR RD STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8301
Mailing Address - Country:US
Mailing Address - Phone:770-683-6921
Mailing Address - Fax:
Practice Address - Street 1:775 POPLAR RD STE 130
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8301
Practice Address - Country:US
Practice Address - Phone:770-683-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA008020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant