Provider Demographics
NPI:1871114637
Name:MCGIBONEY, JUSTINE ELISE (MD)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ELISE
Last Name:MCGIBONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:ELISE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1720 2ND AVENUE SOUTH SRC-044A
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-7330
Mailing Address - Country:US
Mailing Address - Phone:205-975-0826
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S # 44A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:205-975-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.45956207PH0002X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine