Provider Demographics
NPI:1437181138
Name:GIBSON, CARTER ELISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:ELISHA
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4181 HOSPITAL DR NE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:770-787-4700
Mailing Address - Fax:770-784-0435
Practice Address - Street 1:4181 HOSPITAL DR NE
Practice Address - Street 2:SUITE 401
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-787-4700
Practice Address - Fax:770-784-0435
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine