Provider Demographics
NPI:1538279997
Name:TURNER, GEORGE RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RANDOLPH
Last Name:TURNER
Suffix:
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 1:1325 EASTMORELAND AVE
Mailing Address - Street 2:SUITE 580
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3519
Mailing Address - Country:US
Mailing Address - Phone:901-726-1056
Mailing Address - Fax:901-726-5867
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 580
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-726-1056
Practice Address - Fax:901-726-5867
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4047208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3113437Medicaid
TN3113437Medicare ID - Type Unspecified
TN3113437Medicaid