Healthcare Provider Details

I. General information

NPI: 1033022520
Provider Name (Legal Business Name): CARLA CHRISTINE S GIBSON APC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5771 SPRINGFIELD PL
ELLENWOOD GA
30294-3922
US

IV. Provider business mailing address

5771 SPRINGFIELD PL
ELLENWOOD GA
30294-3922
US

V. Phone/Fax

Practice location:
  • Phone: 404-858-6595
  • Fax:
Mailing address:
  • Phone: 404-858-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC009902
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: