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NPI Code Detail

MEDICARE: GRACE MCGIBBON RN

MEDICARE: GRACE MCGIBBON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN311634GA

General Provider Information

NPI Number : 1053265298
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE MCGIBBON RN
Provider Business Mailing Address
First Line : 102 FOREST LAWN
Second Line :
City : BONAIRE
State : GA
Zip : 31005-4429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1960 HWY 247 CONNECTOR
Second Line :
City : BYRON
State : GA
Zip : 31008-5663
Country : US
Telephone Number : 478-654-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2026
Last Update Date : 02/24/2026

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