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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