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Individual

DR. RALPH ATHEN TESSENEER III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1690 SKYLYN DR STE 300A, SPARTANBURG, SC 29307-1022
(864) 342-4000
(864) 596-7409
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8959
SC
207QA0505X
Adult Medicine Physician
8959
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
089594
SC
01
P00386809
MEDICARE RAILROAD PTAN#
GA
01
SCE4905019
MEDICARE PIN
SC
Enumeration date
01/07/2006
Last updated
12/31/2020
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