1164609335 NPI number — MRS. HEATHER NOEL GIBBONS MD

Table of content: MRS. HEATHER NOEL GIBBONS MD (NPI 1164609335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164609335 NPI number — MRS. HEATHER NOEL GIBBONS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBONS
Provider First Name:
HEATHER
Provider Middle Name:
NOEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIBBONS-DOIG
Provider Other First Name:
HEATHER
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164609335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 COLLIER RD NW
Provider Second Line Business Mailing Address:
SUITE 1010
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-355-4885
Provider Business Mailing Address Fax Number:
404-355-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 COLLIER RD
Provider Second Line Business Practice Location Address:
SUITE 1010
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-355-4885
Provider Business Practice Location Address Fax Number:
404-355-2210
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  002276 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 511I160152 . This is a "MEDICARE ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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