Healthcare Provider Details

I. General information

NPI: 1104814797
Provider Name (Legal Business Name): MICHAEL GARY ALLISON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SOUTH MAIN STREET
CROSSVILLE TN
38555
US

IV. Provider business mailing address

1307 WEST AVE SUITE 102
CROSSVILLE TN
38555-5107
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-9511
  • Fax: 931-456-4405
Mailing address:
  • Phone: 931-456-4433
  • Fax: 931-456-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS-006810L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number18895
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number188099
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number6347
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1974
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number188099
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: