Healthcare Provider Details

I. General information

NPI: 1578256541
Provider Name (Legal Business Name): FAUSTINE CEASOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 18TH ST E
TIFTON GA
31794-3648
US

IV. Provider business mailing address

PO BOX 2650
TIFTON GA
31793-2650
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-7120
  • Fax: 229-353-7779
Mailing address:
  • Phone: 229-402-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: