Provider Demographics
NPI:1619730447
Name:GIBSON, EUNICE A (CERTIFICATION)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 HIGHWAY 20 W STE 223
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7311
Mailing Address - Country:US
Mailing Address - Phone:305-205-8999
Mailing Address - Fax:
Practice Address - Street 1:1438 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4470
Practice Address - Country:US
Practice Address - Phone:305-205-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty