National Provider Identifier Database

CELESTIAL PLASTIC AND RECONSTRUCTIVE SURGERY
Plastic and Reconstructive Surgery


Contact Information

CELESTIAL PLASTIC AND RECONSTRUCTIVE SURGERY
2230 GODBY RD
COLLEGE PARK, GA30349-5002
Phone: 404-268-0828
Fax: 404-393-1695
Website:
Specialty Taxonomy Code
* Plastic and Reconstructive Surgery 2086S0122X
Plastic Surgery 208200000X

* Indicates primary specialty

NPI Profile & details for CELESTIAL PLASTIC AND RECONSTRUCTIVE SURGERY

NPI Number 1619479201
Legal business name
LBN
CELESTIAL PLASTIC AND RECONSTRUCTIVE SURGERY
Authorized official RUTH CELESTIN - (PLASTIC SURGEON, OWNER)
Entity Organization
Organization subpart No
Enumeration date 02/28/2018
Last updated 06/01/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers
  • GA License #: 70539
  • GA Medicaid: 003211917A
  • NJ Medicaid: 1972708899
  • Other: DZ9723 RAIROAD MEDICARE PTAN

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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