Provider Demographics
NPI:1316283104
Name:GIBSON, SHEKEITA (RRT)
Entity type:Individual
Prefix:MS
First Name:SHEKEITA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 TRADEWIND RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206
Mailing Address - Country:UM
Mailing Address - Phone:478-973-5055
Mailing Address - Fax:
Practice Address - Street 1:808 TRADE WIND RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3785
Practice Address - Country:US
Practice Address - Phone:478-973-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-24
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0065562278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health