Provider Demographics
NPI:1548274582
Name:GIBBS, MARTHA KRICKEL (NP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:KRICKEL
Last Name:GIBBS
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Gender:F
Credentials:NP
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Mailing Address - Street 1:19412 HIGHWAY 46
Mailing Address - Street 2:P.O BOX 178
Mailing Address - City:RANBURNE
Mailing Address - State:AL
Mailing Address - Zip Code:36273-3505
Mailing Address - Country:US
Mailing Address - Phone:770-836-0870
Mailing Address - Fax:770-836-1837
Practice Address - Street 1:SOUTHWIRE FAMILY MEDICAL CTR
Practice Address - Street 2:1128 SOUTHPARK STREET
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30119-0001
Practice Address - Country:US
Practice Address - Phone:770-836-0870
Practice Address - Fax:770-836-1837
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-08-06
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Provider Licenses
StateLicense IDTaxonomies
GA050776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily