Provider Demographics
NPI:1649278532
Name:MAIKI, CELESTINE O (MD)
Entity type:Individual
Prefix:
First Name:CELESTINE
Middle Name:O
Last Name:MAIKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 SPIVEY STATION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2886
Mailing Address - Country:US
Mailing Address - Phone:404-251-2680
Mailing Address - Fax:404-252-2688
Practice Address - Street 1:7823 SPIVEY STATION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2886
Practice Address - Country:US
Practice Address - Phone:404-251-2680
Practice Address - Fax:404-252-2688
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052283207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA199807383AMedicaid
GA841642192OtherTAX ID
GA841642192OtherTAX ID
GA199807383AMedicaid