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General NPI Number Information
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NPI Number | 1457508160
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Entity Type | Organization
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Legal Business Name | CHARLES E KELLY II MD
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 2835 HWY 231 N SUITE 208A
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City | SHELBYVILLE
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State | TN
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Zip | 37160-7327
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Country | US
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Telephone | 931-231-0559
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 HWY 231 N SUITE 208A
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City | SHELBYVILLE
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State | TN
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Zip | 37160-7327
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Country | US
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Telephone | 931-231-0559
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES E KELLY II
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Credential | MD
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Telephone | 931-629-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | TN
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