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General NPI Number Information
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NPI Number | 1770692238
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Entity Type | Individual
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Provider Name | MARIE C KELLY O.D..
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 110 GLANCY ST SUITE 208
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072
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Country | US
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Telephone | 615-868-2877
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Fax | 615-870-5771
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Provider Business Mailing Address
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Address Line | 110 GLANCY STREET SUITE 208
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072
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Country | US
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Telephone | 615-868-2877
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Fax | 615-870-5771
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TNOD1121
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License Number State | TN
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