Provider Demographics
NPI:1275550022
Name:T.RODERICK HESTER, JR. M.D. PC
Entity Type:Organization
Organization Name:T.RODERICK HESTER, JR. M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-0051
Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:SUITE 640
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-351-0051
Mailing Address - Fax:404-351-0632
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:SUITE 640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-351-0051
Practice Address - Fax:404-351-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012106208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2029Medicare PIN