Individual
GREGG H.D. KESTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 BROYLES DR, SUITE B, JOHNSON CITY, TN 37601-2542
(423) 722-4000
(423) 722-4004
Mailing address
7731 CHEROKEE SPRINGS WAY, KNOXVILLE, TN 37919-9030
(865) 470-2468
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
17126
TN
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
17126
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110098564
RR MEDICARE PIN
TN
05
—
3019399
—
TN
Enumeration date
06/11/2006
Last updated
11/19/2016
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