Healthcare Provider Details

I. General information

NPI: 1235106543
Provider Name (Legal Business Name): WILLIE J CHESTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 US HIGHWAY 231
WETUMPKA AL
36092-3328
US

IV. Provider business mailing address

4452 US HIGHWAY 231
WETUMPKA AL
36092-3328
US

V. Phone/Fax

Practice location:
  • Phone: 334-420-5001
  • Fax: 334-293-6640
Mailing address:
  • Phone: 334-420-5038
  • Fax: 334-420-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO138
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: