Provider Demographics
NPI:1073112512
Name:CORNELIUS TIMOTHIUS, CELINE JOYCE (BDS, MS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CELINE JOYCE
Middle Name:
Last Name:CORNELIUS TIMOTHIUS
Suffix:
Gender:F
Credentials:BDS, MS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 JOHN WESLEY GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-7913
Mailing Address - Fax:706-721-6778
Practice Address - Street 1:1430 JOHN WESLEY GILBERT DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-2441
Practice Address - Fax:706-721-6778
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0004371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX0437Medicaid
GA003242047AMedicaid