Provider Demographics
NPI:1578332805
Name:GIBSON, TAYLOR BURCH
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:BURCH
Last Name:GIBSON
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 1:219 HERSCHEL DR APT B
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2375
Mailing Address - Country:US
Mailing Address - Phone:912-292-3854
Mailing Address - Fax:
Practice Address - Street 1:407 TORI DR STE 2
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-5209
Practice Address - Country:US
Practice Address - Phone:770-800-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician