Individual provider Active NPI

Gary Lynn Tester, LCSW

  • Clinical Social Worker
  • Dalton, GA
National Provider Identifier
1639150584
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1431 Issued in GA
Practice address
313 N Selvidge St Ste 105
Dalton, GA 30720-3261
Phone
(423) 667-4063
Fax
(706) 529-5237
NPI assigned
Nov 8, 2005
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 586 TN
Clinical Social Worker 1041C0700X 1431 GA Primary

Addresses

Primary practice location

313 N Selvidge St Ste 105
Dalton, GA 30720-3261

Mailing address

3621 Glen Oaks Drive
Chattanooga, TN 37412
Phone (423) 867-5290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200324000461 GA Practitioner - Clinical Social Worker 6305274440 Reassigns benefits to 1 organization
Practice locations: Dalton, GA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

313 N Selvidge St
Suite 105
Dalton, GA 30720-3261
Phone (423) 667-4063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1431GAMDClinical Social Worker
586TNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Rivers CSB CurrentSince Jan 21, 2020 Accepting new patients
Highland Rivers CSB CurrentSince Jan 21, 2020 Accepting new patients
Highland Rivers Community Service Board Current Accepting new patients
Hamilton Medical Center, Inc. Past Accepting new patients
Reliant Healthcare LLC Past Accepting new patients

Locations

191 Lamar Haley Pkwy
Canton, GA 30114
Phone (770) 704-1600

1503 N Tibbs Rd
Dalton, GA 30720
Phone (706) 229-4507

900 Shugart Rd
Ste A
Dalton, GA 30720
Phone (706) 270-5005

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1639150584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 GLEN OAKS DRIVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37412",
            "telephone_number": "423-867-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 N SELVIDGE ST STE 105",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203261",
            "telephone_number": "423-667-4063",
            "fax_number": "706-529-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESTER",
        "first_name": "GARY",
        "middle_name": "LYNN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "586",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "1431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

Verify at the official NPI Registry.