Provider Demographics
NPI:1104077148
Name:GIBBS, JAMES G JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:GIBBS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S COOK ST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-3244
Mailing Address - Country:US
Mailing Address - Phone:843-454-1605
Mailing Address - Fax:
Practice Address - Street 1:122 S COOK ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-3244
Practice Address - Country:US
Practice Address - Phone:843-454-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 49322084P0800X
NMMD 2012-00642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC327877Medicaid
SC327877Medicaid
SC3343Medicare PIN