Healthcare Provider Details

I. General information

NPI: 1255319752
Provider Name (Legal Business Name): CELIA C MAMBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HILLANDALE DR SUITE 250
LITHONIA GA
30058-4103
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-5431
  • Fax: 770-981-5515
Mailing address:
  • Phone: 770-981-5431
  • Fax: 770-981-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number039629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: