Healthcare Provider Details

I. General information

NPI: 1942040068
Provider Name (Legal Business Name): EMILY GIBBS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PROVIDENCE PARK DR E STE 203
MOBILE AL
36695-4618
US

IV. Provider business mailing address

2880 DAUPHIN ST
MOBILE AL
36606-2457
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-2667
  • Fax: 251-633-2179
Mailing address:
  • Phone: 251-341-3205
  • Fax: 251-470-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1375A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: