Provider Demographics
NPI:1982255279
Name:GIBBS, SCOTTIE LAMAR (CRNP)
Entity Type:Individual
Prefix:
First Name:SCOTTIE
Middle Name:LAMAR
Last Name:GIBBS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1684
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1684
Mailing Address - Country:US
Mailing Address - Phone:256-494-4968
Mailing Address - Fax:256-494-4215
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1150
Practice Address - Country:US
Practice Address - Phone:256-494-4968
Practice Address - Fax:256-494-4245
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-69652363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care