Healthcare Provider Details

I. General information

NPI: 1558289314
Provider Name (Legal Business Name): COURTNEY ANNE COX GIBSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 W HAMILTON PARK DR
COLUMBUS GA
31909-3004
US

IV. Provider business mailing address

589 SPRING LAKE DR
FORTSON GA
31808-5344
US

V. Phone/Fax

Practice location:
  • Phone: 706-329-7645
  • Fax:
Mailing address:
  • Phone: 843-260-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP263401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: