Healthcare Provider Details

I. General information

NPI: 1659751998
Provider Name (Legal Business Name): ALLISON MAGNUSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON PRATT DAVIS

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W JACKSON ST
CARBONDALE IL
62901-1462
US

IV. Provider business mailing address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 618-549-0721
  • Fax: 618-529-0449
Mailing address:
  • Phone: 865-305-5368
  • Fax: 865-305-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036150083
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number247163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: