Healthcare Provider Details

I. General information

NPI: 1871732834
Provider Name (Legal Business Name): JENNIFER E HESTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977A TAYLOR ST SW
CONYERS GA
30012-5357
US

IV. Provider business mailing address

PO BOX 687
LAWRENCEVILLE GA
30046-0687
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-6677
  • Fax: 770-918-6694
Mailing address:
  • Phone: 770-339-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004416
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: