Provider Demographics
NPI:1154641447
Name:GIBSON, CHRISTIE HUSKEY (PA-AC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:HUSKEY
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2564
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31203-2565
Mailing Address - Country:US
Mailing Address - Phone:478-746-5644
Mailing Address - Fax:478-745-4849
Practice Address - Street 1:380 HOSPITAL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-746-5644
Practice Address - Fax:478-745-4849
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367H00000X
GA5907367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100272DMedicaid
GA580628385OtherTRICARE
GAP01142251OtherRAILROAD MEDICARE
GA003100272AMedicaid
GA003100272CMedicaid
GA714937OtherWELLCARE
GA003100272EMedicaid
GA003100272BMedicaid
GA01777944OtherAMERIGROUP
GA003100272CMedicaid
GA003100272EMedicaid