Provider Demographics
NPI:1619431210
Name:GIBBS, DEBORAH D
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:GIBBS
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 1:1806 S CHRISMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-4504
Mailing Address - Country:US
Mailing Address - Phone:662-775-5070
Mailing Address - Fax:662-775-5070
Practice Address - Street 1:1403 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MS
Practice Address - Zip Code:38774
Practice Address - Country:US
Practice Address - Phone:662-775-5070
Practice Address - Fax:662-775-5070
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care