Provider Demographics
NPI:1518951490
Name:GIBBAS, DONNA LEE (MD)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:LEE
Last Name:GIBBAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 CENTURY CIR NE
Mailing Address - Street 2:STE-14
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3020
Mailing Address - Country:US
Mailing Address - Phone:404-634-7556
Mailing Address - Fax:404-320-3447
Practice Address - Street 1:1740 CENTURY CIR NE
Practice Address - Street 2:STE-14
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3020
Practice Address - Country:US
Practice Address - Phone:404-634-7556
Practice Address - Fax:404-320-3447
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
GAGA15768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00015122DMedicaid
GAD45425Medicare UPIN
GA66BBBBZMedicare ID - Type Unspecified