David C Gibson (NPI# 1467741553, PAC ID# 0143454819) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is EMERGENCY MEDICINE.
| Nation Provider ID (NPI) | 1467741553 |
| PAC ID by PECOS | 0143454819 |
| Professional Enrollment ID | I20141106001324 |
| Full Name | David C Gibson |
| Organization Legal Name | THE BORTOLAZZO GROUP, LLC |
| Address |
2518 Jimmy Lee Smith Pkwy Hiram GA 30141-2068 |
| Phone Number | 4706447000 |
| Gender | M |
| Medical School | PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2011 |
| Primary Specialty | EMERGENCY MEDICINE |
| Group Practice PAC ID | 3476554320 |
| Number of Group Practice Members | 55 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110042 | WELLSTAR PAULDING HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 | 4706447000 | THE BORTOLAZZO GROUP, LLC |
| Organization Legal Name | THE BORTOLAZZO GROUP, LLC |
| Physicians | 54 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Henry C Nygren | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Audrey C M Williams | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Thomas C Crouch | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Brett H Cannon | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Steven B Core | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Latanya Taneia Gobin | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Nirma D Bustamante | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Jazmin S Raadsen | Nurse Practitioner | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Nicholas Allen Hooper | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Tariq Noohani | Emergency Medicine | The Bortolazzo Group, LLC | 3950 Austell Rd, Austell, GA 30106-1121 |
| Street Address |
2518 JIMMY LEE SMITH PKWY |
| City | HIRAM |
| State | GA |
| Zip | 30141-2068 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Vanchad Memark | General Surgery | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Mopelola Isola | Hospitalist | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Aidenojie E Ihenyen | Hospitalist | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Matthew L Estes | Nurse Practitioner | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Sanath K Allampati | Hospitalist | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Adam C Ferro | Radiation Oncology | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Adanna N Nwachukwu | Hospitalist | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Donna V Wall | Nurse Practitioner | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Sharon C Amaya | Emergency Medicine | The Bortolazzo Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Bruno J Grillo | Physician Assistant | Wellstar Medical Group, LLC | 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141-2068 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Samantha Lavengood Boucher | Chiropractic | 5447 Powder Springs Dallas Swrd, Hiram, GA 30141 | |
| Aubree L Tant | Nurse Practitioner | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Christina Adams | Family Medicine | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Carl Goolsby | Family Medicine | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Laura C Huenink | Nurse Practitioner | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Jeffrey Lanier Tharp | Internal Medicine | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Ramona Payton | Nurse Practitioner | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Roderick H Rhyant | Family Medicine | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Susan E Ashworth | Nurse Practitioner | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| David A Gose | Internal Medicine | Wellstar Medical Group, LLC | 176 Charles Hardy Pkwy C, Hiram, GA 30141-1836 |
| Find all physicians in zip 30141 | |||
| City | HIRAM |
| Zip Code | 30141 |
| Specialty | EMERGENCY MEDICINE |
| City + Specialty | HIRAM + EMERGENCY MEDICINE |
Please comment or provide details below to improve the information on David C Gibson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.