Provider Demographics
NPI:1164411336
Name:CSELEY, MARGOT B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:B
Last Name:CSELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7654
Mailing Address - Country:US
Mailing Address - Phone:770-395-0426
Mailing Address - Fax:888-980-9760
Practice Address - Street 1:268 LAWRENCE ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1617
Practice Address - Country:US
Practice Address - Phone:770-421-7738
Practice Address - Fax:770-421-0394
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00657489AMedicaid
GA08BBVPHMedicare ID - Type Unspecified
GA08BBVPHMedicare PIN