Healthcare Provider Details

I. General information

NPI: 1164609335
Provider Name (Legal Business Name): HEATHER NOEL GIBBONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER NOEL GIBBONS-DOIG MD

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD SUITE 1010
ATLANTA GA
30309-1730
US

IV. Provider business mailing address

105 COLLIER RD NW SUITE 1010
ATLANTA GA
30309-1710
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-4885
  • Fax: 404-355-2210
Mailing address:
  • Phone: 404-355-4885
  • Fax: 404-355-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number002276
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: