Healthcare Provider Details

I. General information

NPI: 1043882707
Provider Name (Legal Business Name): CAROLINE MCGINNIS GIBSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 SEVEN HILLS CONNECTOR STE 101
ACWORTH GA
30101-8985
US

IV. Provider business mailing address

860 SEVEN HILLS CONN UNIT 101
ACWORTH GA
30101
US

V. Phone/Fax

Practice location:
  • Phone: 678-402-0515
  • Fax:
Mailing address:
  • Phone: 678-402-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: