Healthcare Provider Details

I. General information

NPI: 1861591596
Provider Name (Legal Business Name): GEORGE MARSHALL GIBBINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE MARSHALL GIBBINS MD

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 CHRISTINE AVE
ANNISTON AL
36207-5709
US

IV. Provider business mailing address

1029 CHRISTINE AVE
ANNISTON AL
36207-5709
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-0371
  • Fax: 256-236-4181
Mailing address:
  • Phone: 256-237-0371
  • Fax: 256-236-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00005414
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: