Healthcare Provider Details

I. General information

NPI: 1497611313
Provider Name (Legal Business Name): PATTI RENEE GIBSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 31164
AUGUSTA GA
30903-2964
US

IV. Provider business mailing address

1226 DANTIGNAC ST
AUGUSTA GA
30901-2788
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax:
Mailing address:
  • Phone: 706-922-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN066720
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: