Individual
GEORGE THOTTAKARA MATHAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
224 LONG ST, NEW JOHNSONVILLE, TN 37134-2468
(931) 535-3734
(931) 535-3742
Mailing address
224 LONG ST, NEW JOHNSONVILLE, TN 37134-2468
(931) 535-3734
(931) 535-3742
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000038042
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3889576
—
TN
01
—
4074799
BLUE CROSS BLUE SHIELD TN
TN
Enumeration date
01/12/2007
Last updated
01/07/2013
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