Healthcare Provider Details

I. General information

NPI: 1689676157
Provider Name (Legal Business Name): GINARI GIBB PRICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DEVANT ST STE 504
FAYETTEVILLE GA
30214
US

IV. Provider business mailing address

101 DEVANT ST STE 504
FAYETTEVILLE GA
30214-2720
US

V. Phone/Fax

Practice location:
  • Phone: 770-703-4448
  • Fax: 770-703-4038
Mailing address:
  • Phone: 770-703-4448
  • Fax: 770-703-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number056712
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number056712
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056712
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: