Provider Demographics
NPI:1386977924
Name:KESLER, ERNEST BUFORD JR (EDD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:BUFORD
Last Name:KESLER
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 CITY CIRCLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7013
Mailing Address - Country:US
Mailing Address - Phone:912-367-2000
Mailing Address - Fax:912-367-4112
Practice Address - Street 1:375 CITY CIRCLE RD STE A
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-7013
Practice Address - Country:US
Practice Address - Phone:912-367-2000
Practice Address - Fax:912-367-4112
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000453103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist