Provider Demographics
NPI:1831120617
Name:LESTER, JEAN CHERIE (RD LD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CHERIE
Last Name:LESTER
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 MULKEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:678-460-2700
Mailing Address - Fax:770-739-0212
Practice Address - Street 1:1660 MULKEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:678-460-2700
Practice Address - Fax:770-739-0212
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001132133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7909Medicare UPIN
GA71BBBJMedicare ID - Type Unspecified