Basic Information
| Provider Information | |||||||||
| NPI: | 1982643177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LESTER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | OWASA FAMILY MEDICINE | ||||||||
| Address2: | 109 HOSPITAL DRIVE | ||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307012067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066250333 | ||||||||
| FaxNumber: | 7066251269 | ||||||||
| Practice Location | |||||||||
| Address1: | OWASA FAMILY MEDICINE | ||||||||
| Address2: | 109 HOSPITAL DRIVE | ||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307012067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066250333 | ||||||||
| FaxNumber: | 7066251269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 056128 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 879338639 | 05 | GA | MEDICAID |