Provider Demographics
NPI:1063522308
Name:JESTER, KIMBERLY B (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:JESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WALTON WAY
Mailing Address - Street 2:STE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2602
Mailing Address - Country:US
Mailing Address - Phone:706-828-8402
Mailing Address - Fax:
Practice Address - Street 1:905 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-0615
Practice Address - Country:US
Practice Address - Phone:706-312-5437
Practice Address - Fax:706-312-5427
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040112208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000664848AMedicaid
SCG40112Medicaid
G11655Medicare UPIN
GA37BBGFLMedicare ID - Type UnspecifiedGA MEDICARE