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Organization
CELESTIAL PLASTIC AND RECONSTRUCTIVE SURGERY
Active
Organization
CELESTIAL PLASTIC AND RECONSTRUCTIVE SURGERY
Active
Other names
Celestial Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUTH CELESTIN MD (PLASTIC SURGEON, OWNER)
(770) 845-0696
Entity
Organization
Contact information
Practice address
2230 GODBY RD, COLLEGE PARK, GA 30349-5002
(404) 268-0828
(404) 393-1695
Mailing address
3645 MARKETPLACE BLVD STE 130-559, EAST POINT, GA 30344-5747
(770) 845-0696
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
70539
GA
208200000X
Plastic Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003211917A
—
GA
05
—
1972708899
—
NJ
01
—
DZ9723
RAIROAD MEDICARE PTAN
—
Enumeration date
02/28/2018
Last updated
06/01/2022
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