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General NPI Number Information
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NPI Number | 1972708899
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Entity Type | Individual
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Provider Name | RUTH CELESTIN MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 33 UPPER RIVERDALE RD SW STE 115
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 404-268-0828
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Fax | 404-393-1695
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Provider Business Mailing Address
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Address Line | 3645 MARKETPLACE BLVD STE 130-559
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City | EAST POINT
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State | GA
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Zip | 30344-5747
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Country | US
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Telephone | 770-845-0696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 070539
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License Number State | GA
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