Provider Demographics
NPI:1851813778
Name:TOLBERT, CELESTE PEARSON (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:PEARSON
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 REX RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3943
Mailing Address - Country:US
Mailing Address - Phone:678-887-3539
Mailing Address - Fax:
Practice Address - Street 1:2147 REX ROAD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3943
Practice Address - Country:US
Practice Address - Phone:678-887-3539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0507151744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management