Provider Demographics
NPI:1770576639
Name:CELESTIN, STEVEN M (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:CELESTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1730 LAWRENCEVILLE SUWNN ROAD
Mailing Address - Street 2:
Mailing Address - City:LAWRENVECILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:770-338-0089
Mailing Address - Fax:770-338-0091
Practice Address - Street 1:1730 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3507
Practice Address - Country:US
Practice Address - Phone:770-338-0089
Practice Address - Fax:770-338-0091
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58447207Q00000X
OH35.134809207Q00000X
CAC158291207Q00000X
KY51814207Q00000X
TN58165207Q00000X
DEC1-0012892207Q00000X
NY229656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI21779Medicare UPIN
NYA400043068Medicare PIN