Provider Demographics
NPI:1245424373
Name:GILBRIDE, VIRGINIA N (MED)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:N
Last Name:GILBRIDE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:NAYLOR
Mailing Address - State:GA
Mailing Address - Zip Code:31641-2563
Mailing Address - Country:US
Mailing Address - Phone:229-247-4633
Mailing Address - Fax:
Practice Address - Street 1:5975 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:NAYLOR
Practice Address - State:GA
Practice Address - Zip Code:31641-2563
Practice Address - Country:US
Practice Address - Phone:229-247-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator