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General NPI Number Information
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NPI Number | 1336912823
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Entity Type | Individual
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Provider Name | MR. WILLIE GIBSON
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 6113 BLUE LANTERN RD
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City | GIBSONVILLE
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State | NC
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Zip | 27249-8737
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Country | US
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Telephone | 336-274-1269
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Fax | 336-272-2387
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Provider Business Mailing Address
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Address Line | 2302 W MEADOWVIEW RD STE 208
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City | GREENSBORO
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State | NC
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Zip | 27407-3706
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Country | US
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Telephone | 336-274-1269
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Fax | 336-272-2387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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