Provider Demographics
NPI:1164609335
Name:GIBBONS, HEATHER NOEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NOEL
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:NOEL
Other - Last Name:GIBBONS-DOIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:105 COLLIER RD NW
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1710
Mailing Address - Country:US
Mailing Address - Phone:404-355-4885
Mailing Address - Fax:404-355-2210
Practice Address - Street 1:105 COLLIER RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1730
Practice Address - Country:US
Practice Address - Phone:404-355-4885
Practice Address - Fax:404-355-2210
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I160152OtherMEDICARE ID
GAGRP4747Medicare PIN