Provider Demographics
NPI:1194762831
Name:GIBBES, CAROLINE L
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:L
Last Name:GIBBES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LAUREL ST STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-256-7494
Mailing Address - Fax:803-799-0746
Practice Address - Street 1:2601 LAUREL ST STE 110
Practice Address - Street 2:
Practice Address - City:COLA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-256-7494
Practice Address - Fax:803-799-0746
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC092054 PC1477Medicaid
SC1143660001Medicare NSC
C60571Medicare UPIN
SC092054 PC1477Medicaid