Provider Demographics
NPI:1033107859
Name:TESTERMAN, GEORGE M JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:TESTERMAN
Suffix:JR
Gender:M
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:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-224-5826
Mailing Address - Fax:423-224-6242
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-5826
Practice Address - Fax:423-224-6242
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12920208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A96585Medicare UPIN
TN3056975Medicare ID - Type Unspecified
TN103I022881Medicare PIN
TN103I022447Medicare PIN