Provider Demographics
NPI:1700896156
Name:GIBBS, JON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:CHRISTOPHER
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 211550
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-1550
Mailing Address - Country:US
Mailing Address - Phone:706-855-9860
Mailing Address - Fax:706-860-7124
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-855-9860
Practice Address - Fax:706-860-7124
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCGBSMedicare Oscar/Certification
GAF78069Medicare UPIN