Provider Demographics
NPI:1194189084
Name:TIBBS, GEOFFREY (CO, CPA)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:TIBBS
Suffix:
Gender:M
Credentials:CO, CPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 WESTGATE CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3041
Mailing Address - Country:US
Mailing Address - Phone:336-546-7165
Mailing Address - Fax:866-403-2483
Practice Address - Street 1:1345 WESTGATE CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3041
Practice Address - Country:US
Practice Address - Phone:336-546-7165
Practice Address - Fax:866-403-2483
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497158554Medicaid