Healthcare Provider Details

I. General information

NPI: 1851373765
Provider Name (Legal Business Name): KELLIE MORRIS TOLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SUNDAY DR STE 102
RALEIGH NC
27607-5151
US

IV. Provider business mailing address

1500 SUNDAY DR STE 102
RALEIGH NC
27607-5151
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-2413
  • Fax: 919-322-2416
Mailing address:
  • Phone: 919-322-2413
  • Fax: 919-322-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2006-00403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: