Provider Demographics
NPI:1598927980
Name:GIBSON, ERICKA CAMILLE (MD)
Entity Type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:CAMILLE
Last Name:GIBSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:202-448-1620
Practice Address - Street 1:2400 MOUNT ZION PKWY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD COMPREHENSIVE MEDICAL CENTE
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:770-603-3649
Practice Address - Fax:202-448-1620
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-01-10
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Provider Licenses
StateLicense IDTaxonomies
DCMD040417207V00000X
PAMT192768207V00000X
GA077001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology