Provider Demographics
NPI:1447048814
Name:CHWALIBOG, ALISON KYLE
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:KYLE
Last Name:CHWALIBOG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:KYLE
Other - Last Name:WICKLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3833 CORINTH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-3068
Mailing Address - Country:US
Mailing Address - Phone:410-703-6947
Mailing Address - Fax:
Practice Address - Street 1:3833 CORINTH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-3068
Practice Address - Country:US
Practice Address - Phone:410-703-6947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program