Provider Demographics
NPI:1255319752
Name:MAMBY, CELIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:CELIA
Middle Name:C
Last Name:MAMBY
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 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-981-5431
Mailing Address - Fax:770-981-5515
Practice Address - Street 1:5700 HILLANDALE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4103
Practice Address - Country:US
Practice Address - Phone:770-981-5431
Practice Address - Fax:770-981-5515
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039629207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000639878ACMedicaid
GA000639878ACMedicaid
GA202I832073Medicare PIN