Healthcare Provider Details

I. General information

NPI: 1407081581
Provider Name (Legal Business Name): TIFFANY ANN GIBBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 TROTTERS RUN
MACON GA
31210-8653
US

IV. Provider business mailing address

PO BOX 26096
MACON GA
31221-6096
US

V. Phone/Fax

Practice location:
  • Phone: 858-337-0498
  • Fax: 478-750-7756
Mailing address:
  • Phone: 478-750-7780
  • Fax: 478-750-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: