Provider Demographics
NPI:1053346296
Name:GIBSON, AUDREY B (PA-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:B
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LANE NE
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-531-3711
Mailing Address - Fax:770-531-3718
Practice Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LANE NE
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-531-3711
Practice Address - Fax:770-531-3718
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1404363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical