Provider Demographics
NPI:1508056086
Name:TANYA TESTINO
Entity Type:Organization
Organization Name:TANYA TESTINO
Other - Org Name:STAMEN MEDICAL SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TESTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-7100
Mailing Address - Street 1:4806 TECHNOLOGY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-863-7100
Mailing Address - Fax:
Practice Address - Street 1:4806 TECHNOLOGY DRIVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-863-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5957570001Medicare NSC