Provider Demographics
NPI:1891969291
Name:SANDRA H. GIBBS, M.D.
Entity Type:Organization
Organization Name:SANDRA H. GIBBS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDES
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-934-9714
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-0497
Mailing Address - Country:US
Mailing Address - Phone:478-934-9714
Mailing Address - Fax:478-934-9716
Practice Address - Street 1:145 E PEACOCK ST
Practice Address - Street 2:SUITE #3
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-7846
Practice Address - Country:US
Practice Address - Phone:478-934-9714
Practice Address - Fax:478-934-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00449743SMedicaid
GA00449743SMedicaid
GAGRP3440Medicare PIN