Provider Demographics
NPI:1720029101
Name:KUCICH, ALISON DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:DAWN
Last Name:KUCICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1483 NASHVILLE PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-7144
Mailing Address - Country:US
Mailing Address - Phone:615-230-8601
Mailing Address - Fax:615-230-9750
Practice Address - Street 1:1483 NASHVILLE PIKE
Practice Address - Street 2:SUITE 302
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-7144
Practice Address - Country:US
Practice Address - Phone:615-230-8601
Practice Address - Fax:615-230-9750
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513218Medicaid
TNP00724136OtherRAILROAD MEDICARE
TN38282561Medicare PIN