Provider Demographics
NPI:1518934579
Name:BADDOUR, GEORGE ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROBERT
Last Name:BADDOUR
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 1:1926 ALCOA HWY
Mailing Address - Street 2:BLDG. F, SUITE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1545
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:BLDG. F, SUITE 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1545
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12140207X00000X
TN12140207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0940072OtherUNITED HEALTH CARE
TN3011599Medicaid
TN3071400OtherBLUE CROSS BLUE SHIELD
TN100021943OtherTENNCARE
TN419940880OtherTRICARE
TN200030080OtherRAILROAD MEDICARE
TNTN0111OtherJOHN DEERE HEALTHCARE
TNTN0112OtherJOHN DEERE HEALTHCARE
TNTN0175OtherJOHN DEERE HEALTHCARE
TN4664594OtherAETNA
TN3011594Medicare PIN
TNTN0175OtherJOHN DEERE HEALTHCARE
3011592Medicare ID - Type Unspecified
TN30115901Medicare PIN
TNTN0112OtherJOHN DEERE HEALTHCARE
TN4664594OtherAETNA
3011591Medicare ID - Type Unspecified
TN103I202416Medicare PIN