Provider Demographics
NPI:1417098542
Name:GIBSON, TAMMY IRIS
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:IRIS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 COLUMBUS LANCASTER RD NW
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9615
Mailing Address - Country:US
Mailing Address - Phone:614-833-4666
Mailing Address - Fax:
Practice Address - Street 1:7505 COLUMBUS LANCASTER RD NW
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9615
Practice Address - Country:US
Practice Address - Phone:614-833-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH266-1445Medicaid