Provider Demographics
NPI:1831222835
Name:WILCOX, KIRK A (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 EXECUTIVE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7916
Mailing Address - Country:US
Mailing Address - Phone:423-870-2030
Mailing Address - Fax:423-875-6405
Practice Address - Street 1:1025 EXECUTIVE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7916
Practice Address - Country:US
Practice Address - Phone:423-870-2030
Practice Address - Fax:423-875-6405
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025560207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN080158101OtherMEDICARE RR
TN3082742Medicaid
TN3720420Medicare PIN
TN3082749Medicare PIN
TNF81240Medicare UPIN