Provider Demographics
NPI:1548224959
Name:GIBSON, ANDREW BATES III (MS, ATC/L)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:BATES
Last Name:GIBSON
Suffix:III
Gender:M
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 THISTLEDOWN
Mailing Address - Street 2:#2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-301-1378
Mailing Address - Fax:901-843-3749
Practice Address - Street 1:2000 NORTH PARKWAY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-1690
Practice Address - Country:US
Practice Address - Phone:901-843-3465
Practice Address - Fax:901-843-3749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer