Healthcare Provider Details

I. General information

NPI: 1164980025
Provider Name (Legal Business Name): CELESTE N RHODES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

4741 NUTMEG WAY SW
LILBURN GA
30047-4376
US

V. Phone/Fax

Practice location:
  • Phone: 251-604-0609
  • Fax:
Mailing address:
  • Phone: 251-604-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN251422
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN251422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: