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General NPI Number Information
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NPI Number | 1548224959
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Entity Type | Individual
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Provider Name | ANDREW BATES GIBSON III MS, ATC/L
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2000 NORTH PARKWAY
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City | MEMPHIS
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State | TN
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Zip | 38112-1690
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Country | US
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Telephone | 901-843-3465
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Fax | 901-843-3749
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Provider Business Mailing Address
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Address Line | 846 THISTLEDOWN #2
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City | MEMPHIS
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State | TN
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Zip | 38117
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Country | US
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Telephone | 901-301-1378
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Fax | 901-843-3749
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 862
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License Number State | TN
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