Matthew Mackinnon Gibbs
Student in an Organized Health Care Education/Training Program in St Simons Is, GA. Individual provider (NPI-1).
NPI number1982186342
StatusActive
Last updated in NPPESSep 2, 2018
Details
- NPI
- 1982186342
- Entity type
- Individual (NPI-1)
- Name
- Matthew Mackinnon Gibbs
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 2, 2018
- Last updated
- Sep 2, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
211 Village DrSt Simons Is, GA 31522
Phone 912-580-9811
Mailing address
211 Village DrSt Simons Is, GA 31522
Phone 912-580-9811
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