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General NPI Number Information
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NPI Number | 1407089790
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Entity Type | Organization
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Legal Business Name | LEXINGTON PSYCHIATRIC GROUP, PSC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 1030 MONARCH ST SUITE 100
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City | LEXINGTON
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State | KY
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Zip | 40513-1843
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Country | US
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Telephone | 859-296-0066
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Fax | 859-296-1155
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Provider Business Mailing Address
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Address Line | 1030 MONARCH ST SUITE 100
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City | LEXINGTON
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State | KY
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Zip | 40513-1843
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Country | US
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Telephone | 859-296-0066
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Fax | 859-296-1155
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CHARLES I SHELTON
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Credential | D.O.
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Telephone | 859-296-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 02282
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License Number State | KY
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