Healthcare Provider Details

I. General information

NPI: 1922097419
Provider Name (Legal Business Name): JAMES ARTHUR GIBSON MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST RTBN MCRD ERR BUILDING 592
PARRIS ISLAND SC
29905-6100
US

IV. Provider business mailing address

168 BELLA WAY
BEAUFORT SC
29906-2402
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-4481
  • Fax:
Mailing address:
  • Phone: 662-231-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: