Provider Demographics
NPI:1972708899
Name:CELESTIN, RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:CELESTIN
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 1:3645 MARKETPLACE BLVD STE 130-559
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:770-845-0696
Mailing Address - Fax:
Practice Address - Street 1:33 UPPER RIVERDALE RD SW STE 115
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:404-268-0828
Practice Address - Fax:404-393-1695
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070539208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery