Healthcare Provider Details

I. General information

NPI: 1518198456
Provider Name (Legal Business Name): JULIE DIANE GIBBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 OLD MONTGOMERY HWY
BIRMINGHAM AL
35209-5750
US

IV. Provider business mailing address

5301 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7542
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-2260
  • Fax:
Mailing address:
  • Phone: 205-879-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD.47476
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD.47176
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD47176
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: