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NPI Code Detail

MEDICARE: DAVID CHARLES GIBSON DO

MEDICARE: DAVID CHARLES GIBSON DO
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
1207P00000XEmergency Medicine Physician34-010859OH
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1467741553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID CHARLES GIBSON DO
Provider Business Mailing Address
First Line : 5665 NEW NORTHSIDE DR
Second Line :
City : ATLANTA
State : GA
Zip : 30328-5831
Country : US
Telephone Number : 770-874-5400
Fax Number : 770-874-5433
Provider Business Practice Location Address
First Line : 2518 JIMMY LEE SMITH PKWY
Second Line :
City : HIRAM
State : GA
Zip : 30141-2068
Country : US
Telephone Number : 470-644-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2011
Last Update Date : 12/04/2025

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