Provider Demographics
NPI:1336304609
Name:GIBSON, TESSA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2112 SHORTER AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2042
Mailing Address - Country:US
Mailing Address - Phone:706-295-1184
Mailing Address - Fax:706-236-1919
Practice Address - Street 1:2112 SHORTER AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2042
Practice Address - Country:US
Practice Address - Phone:706-295-1184
Practice Address - Fax:706-236-1919
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61739207R00000X
OH35096426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine