Provider Demographics
NPI:1104813211
Name:GILSON, KAREN M (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SYCAMORE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3955
Mailing Address - Country:US
Mailing Address - Phone:423-284-4449
Mailing Address - Fax:
Practice Address - Street 1:1260 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375
Practice Address - Country:US
Practice Address - Phone:931-598-4141
Practice Address - Fax:931-598-5198
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060733207Q00000X
TN1092225410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956AMedicaid
GA581410404OtherTRICARE/HUMANA
111815Medicare Oscar/Certification
GA000211956AMedicaid