MEDICARE: KELLIE MORRIS TOLIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2006-00403	NC

General Provider Information

NPI Number	:	1851373765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE MORRIS TOLIN MD

Provider Business Mailing Address
First Line	:	1500 SUNDAY DR STE 102
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5151
Country	:	US
Telephone Number	:	919-322-2413
Fax Number	:	919-322-2416

Provider Business Practice Location Address
First Line	:	1500 SUNDAY DR STE 102
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5151
Country	:	US
Telephone Number	:	919-322-2413
Fax Number	:	919-322-2416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/10/2022

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