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NPI Code Detail

MEDICARE: MARTI RENEE GIBBS MD

MEDICARE: MARTI RENEE GIBBS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician049294GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
580177932OTHERGARR MEDICARE-GRP # CC4177

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110045228OTHERGAAMERIGROUP
2336006OTHERGAWELLCARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
452862399OTHERGABCBS
66794635OTHERGACIGNA
70100985OTHERGAUNITED HEALTHCARE
87809239OTHERGAAETNA

General Provider Information

NPI Number : 1083694905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTI RENEE GIBBS MD
Provider Business Mailing Address
First Line : PO BOX 658
Second Line :
City : GAINESVILLE
State : GA
Zip : 30503-0658
Country : US
Telephone Number : 770-718-1122
Fax Number : 770-535-7445
Provider Business Practice Location Address
First Line : 4222 FAIRBANKS DR
Second Line :
City : OAKWOOD
State : GA
Zip : 30566-2811
Country : US
Telephone Number : 770-534-6053
Fax Number : 770-534-6695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/18/2011

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Directions to “ MARTI RENEE GIBBS MD” Practice Location

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