Provider Demographics
NPI:1164143509
Name:HOLSTICK, LESTER JAMES
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:JAMES
Last Name:HOLSTICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S LONG ST LOT 1002
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6377
Mailing Address - Country:US
Mailing Address - Phone:334-707-4024
Mailing Address - Fax:
Practice Address - Street 1:1400 S LONG ST LOT 1002
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6377
Practice Address - Country:US
Practice Address - Phone:334-707-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3821960172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty