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General NPI Number Information
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NPI Number | 1386977924
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Entity Type | Individual
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Provider Name | ERNEST BUFORD KESLER JR. EDD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 375 CITY CIRCLE RD STE A
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City | BAXLEY
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State | GA
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Zip | 31513-7013
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Country | US
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Telephone | 912-367-2000
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Fax | 912-367-4112
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Provider Business Mailing Address
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Address Line | 375 CITY CIRCLE RD STE A
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City | BAXLEY
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State | GA
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Zip | 31513-7013
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Country | US
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Telephone | 912-367-2000
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Fax | 912-367-4112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY000453
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License Number State | GA
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