Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 17126 | TN |
N | 111NI0900X | Internist | 17126 | TN |
Y | 207RA0401X | Internist - Addiction Medicine | 17126 | TN |
NPI | 1376585919 |
---|---|
Provider Name | Gregg H.d. Kesterson |
First Address | Knoxville, TN 37919-9030 |
Second Address | Johnson City, TN 37601-2542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 19/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110098564 | RR MEDICARE PIN (01) | TN |
3019399 | (05) | TN |
A98311 | (02) |