Mark C. Gibbons, D.O.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

054569 Issued in GA

Practice address

1111 Griffin Ave
Suite 1a
Eastman, GA 31023-9101

Phone

(478) 448-4416

Fax

(478) 448-4423

NPI assigned

Jul 21, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southcoast Medical Group, LLC

  • Family Medicine Physician
  • Savannah, GA
  • NPI 1467451922
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310601600000",
    "number": "1346249257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 GRIFFIN AVE",
            "address_2": "SUITE 1A",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310239101",
            "telephone_number": "478-448-4416",
            "fax_number": "478-448-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GRIFFIN AVE",
            "address_2": "SUITE 1A",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310239101",
            "telephone_number": "478-448-4416",
            "fax_number": "478-448-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "MARK",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2011-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "054569",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "2008-01266",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emil B Georgi, MD
• Georgia CVS Pharmacy LLC
• Georgia Dental Associates, LLC
• Georgia Dental Associates, PC
• Georgia Oxygen Pharmacy
• John A Glenn Jr., MD
• Global Eastman LLC
• Golden Personal Care Home, Inc.
• Steven Wade Grantham, DC
• Cristine Grauberger, PT, DPT

• Urology Physician in Eastman, GA
• Providers in Eastman, GA by specialty
• Urology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.