Provider Demographics
NPI:1558095968
Name:HESTER, CHARLES LYNN II
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LYNN
Last Name:HESTER
Suffix:II
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 1:125 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1618
Mailing Address - Country:US
Mailing Address - Phone:423-664-9323
Mailing Address - Fax:
Practice Address - Street 1:125 LAUREL DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1618
Practice Address - Country:US
Practice Address - Phone:423-664-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker