Provider Demographics
NPI:1164713285
Name:GILBERT, JEFFREY ALLEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:GILBERT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROBINS WEST PKWY
Mailing Address - Street 2:APT. 217
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8121
Mailing Address - Country:US
Mailing Address - Phone:478-284-2011
Mailing Address - Fax:478-825-6889
Practice Address - Street 1:100 ROBINS WEST PKWY
Practice Address - Street 2:APT. 217
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8121
Practice Address - Country:US
Practice Address - Phone:478-284-2011
Practice Address - Fax:478-825-6889
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer