Provider Demographics
NPI:1811668452
Name:GIBANICA, SEID
Entity type:Individual
Prefix:
First Name:SEID
Middle Name:
Last Name:GIBANICA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5567 PRINCE PHILLIP WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3323
Mailing Address - Country:US
Mailing Address - Phone:404-271-8609
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTURY PKWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3125
Practice Address - Country:US
Practice Address - Phone:470-322-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant