Provider Demographics
NPI:1316977812
Name:GIBSON, WILLIAM DONALD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DONALD
Last Name:GIBSON
Suffix:
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 1:1113 MURFREESBORO RD
Mailing Address - Street 2:STE 319
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1312
Mailing Address - Country:US
Mailing Address - Phone:615-269-0652
Mailing Address - Fax:615-269-0135
Practice Address - Street 1:1113 MURFREESBORO RD STE 319
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1312
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:615-814-2924
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35020207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64041098OtherKY MEDICAID
TN3861367Medicaid
TNP00339020OtherRAILROAD MEDICARE
TN4007978OtherBCBS
TN3861369Medicaid
TN4013360OtherSTONES RIVER IPA
TNP00339020OtherRAILROAD MEDICARE
TN3861367Medicare ID - Type Unspecified
TN3861369Medicare PIN