Active NPI
Teira Lynn Gibson
- Pharmacist
- Mableton, GA
National Provider Identifier
1629345533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH022969
- Practice address
- 5000 Floyd Rd SW
Mableton, GA 30126-1608 - Phone
- (770) 819-9420
- NPI assigned
- Nov 20, 2011
- Last updated
- Dec 23, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH022969 | GA | Primary |
Addresses
Primary practice location
5000 Floyd Rd SW
Mableton, GA 30126-1608
Mailing address
5000 Floyd Rd SW
Mableton, GA 30126-1608
Phone (770) 819-9420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH022969 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
5000 Floyd Rd SW
Mableton, GA 30126
Phone (318) 425-6280
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671753600000",
"number": "1629345533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 FLOYD RD SW",
"city": "MABLETON",
"state": "GA",
"postal_code": "301261608",
"telephone_number": "770-819-9420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 FLOYD RD SW",
"city": "MABLETON",
"state": "GA",
"postal_code": "301261608",
"telephone_number": "770-819-9420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "TEIRA",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-20",
"last_updated": "2022-12-23",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH022969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mableton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.