Provider Demographics
NPI:1245201250
Name:KESTERSON, GEORGINA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:KESTERSON
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 1:10579 BENT TREE VW
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5988
Mailing Address - Country:US
Mailing Address - Phone:901-482-0207
Mailing Address - Fax:828-484-2057
Practice Address - Street 1:10579 BENT TREE VW
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5988
Practice Address - Country:US
Practice Address - Phone:901-482-0207
Practice Address - Fax:828-484-2057
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22804207L00000X
TN27587207L00000X
GA33167207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126012Medicaid
TN3097335Medicaid
MO208281006Medicaid
AR97274OtherBLUECROSS BLUESHIELD
TN3076997OtherBLUECROSS BLUESHIELD
AR129644001Medicaid
50048038OtherMEDICARE RAILROAD
TN3076997OtherBLUECROSS BLUESHIELD