| Gibraltar Biz, Llc | |
|
5505 E Mountain St Stone Mountain GA 30083-3027 | |
| (678) 485-3308 | |
| Not Available |
| Full Name | Gibraltar Biz, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 5505 E Mountain St, Stone Mountain, Georgia |
| Authorized Official Name and Position | Fritha Skinner Dinwiddie (OWNER) |
| Authorized Official Contact | 6784853308 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gibraltar Biz, Llc 5505 E Mountain St Stone Mountain GA 30083-3027 Ph: (678) 485-3308 | Gibraltar Biz, Llc 5505 E Mountain St Stone Mountain GA 30083-3027 Ph: (678) 485-3308 |
| NPI Number | 1013680388 |
|---|---|
| Provider Enumeration Date | 07/31/2021 |
| Last Update Date | 07/31/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013680388 | NPI | - | NPPES |
| D1103 | Other | MS | STATE BOARD OF LICENSURE |
| DT85347 | Other | TX | STATE BOARD OF LICENSURE |
| ND9557 | Other | FL | STATE BOARD OF LICENSURE |
| 677280 | Other | COMMISSION ON DIETETIC REGISTRATION, ACADEMY OF NUTRITION AND DIETETICS | |
| L003247 | Other | NC | STATE BOARD OF LICENSURE |
| 1093126997 | Medicaid | GA | |
| 893 | Other | AL | STATE BOARD OF LICENSURE |
| 2273 | Other | KS | STATE BOARD OF LICENSURE |
| 878 | Other | GA | STATE BOARD OF LICENSURE |
| LDN2393 | Other | TN | STATE BOARD OF LICENSURE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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