Provider Demographics
NPI:1295818250
Name:LESTER, FLEET (PA)
Entity Type:Individual
Prefix:
First Name:FLEET
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 SWEET BOTTOM CT SW
Mailing Address - Street 2:SW
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1288 SWEET BOTTOM CT SW
Practice Address - Street 2:SW
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5222
Practice Address - Country:US
Practice Address - Phone:404-778-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01701367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R70605Medicare UPIN
GA97BBFNPMedicare ID - Type Unspecified