MEDICARE: DR. GRIFFIN GIBSON II 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
1	2084P0800X	Psychiatry Physician	MD.35800	AL

General Provider Information

NPI Number	:	1104203439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRIFFIN GIBSON II MD

Provider Business Mailing Address
First Line	:	301 BROWN SPRINGS RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7005
Country	:	US
Telephone Number	:	334-747-4159
Fax Number	:

Provider Business Practice Location Address
First Line	:	4371 NARROW LANE RD STE 205
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2975
Country	:	US
Telephone Number	:	334-747-7780
Fax Number	:	334-747-7790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	01/12/2023

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