Healthcare Provider Details

I. General information

NPI: 1053265298
Provider Name (Legal Business Name): GRACE MCGIBBON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WATSON BLVD
WARNER ROBINS GA
31093-3431
US

IV. Provider business mailing address

102 FOREST LAWN
BONAIRE GA
31005-4429
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-4281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP311634
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN311634
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: