Samuel Gibson, PA
Individual provider Active NPI Physician Assistant · Hapeville, GA
NPI 1134429806 · NPPES record last updated Oct 28, 2010
Key facts
- NPI
- 1134429806
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2675 (GA)
- Practice address
- 791 Oak St
Hapeville, GA 30354-1748 - Phone
- (404) 601-2000
- Fax
- (404) 559-0806
- NPI assigned
- Oct 28, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2675 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ageless Mens Health | Past | Accepting new patients | |
| Health Education Assessment and Leadership, Inc | Past | Accepting new patients | |
| Friendship Community Healthcare Inc | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DJFHBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2675 | GA | Yes |
Addresses
Primary practice location
791 Oak St
Hapeville, GA 30354-1748
Mailing address
791 Oak Street
Hapeville, GA 30354
Phone (404) 601-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2675 | Other | GA | GEOGIA PHYSICIAN ASSISTANT LICENSE |
Other names
- Sam Gibson
Other providers in Hapeville, GA
- Reginald Keith Franklin
- Joi Freemont
- Ameera Fujah
- Fulton County Schools
- Tracy Gantlin-Monroy
- James Edward Golden II
- Trevis Gullatt
- Hapeville Dialysis Center LLC
- Hapeville Health Center
- Hapeville Manor Assisted Living Facility, Inc
All providers in Hapeville, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.