Provider Demographics
NPI:1881252484
Name:GIBBS, AMELIA JOHNSON (CSFA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:JOHNSON
Last Name:GIBBS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6544
Mailing Address - Country:US
Mailing Address - Phone:225-924-7514
Mailing Address - Fax:225-922-8917
Practice Address - Street 1:8425 CUMBERLAND PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6544
Practice Address - Country:US
Practice Address - Phone:225-924-7514
Practice Address - Fax:225-922-8917
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant