Healthcare Provider Details

I. General information

NPI: 1366817611
Provider Name (Legal Business Name): MICHAEL A GIBLIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 SAGE RD N STE 800
WHITE HOUSE TN
37188-9362
US

IV. Provider business mailing address

491 SAGE RD N STE 800
WHITE HOUSE TN
37188-9362
US

V. Phone/Fax

Practice location:
  • Phone: 615-672-4089
  • Fax: 615-672-7849
Mailing address:
  • Phone: 615-672-4089
  • Fax: 615-672-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2920
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: