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NPI Code Detail

MEDICARE: CHARLES E KELLY II MD

MEDICARE: CHARLES E KELLY II 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
1207RG0100XGastroenterology PhysicianTN

General Provider Information

NPI Number : 1457508160
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES E KELLY II MD
Provider Business Mailing Address
First Line : 2835 HWY 231 N
Second Line : SUITE 208A
City : SHELBYVILLE
State : TN
Zip : 37160-7327
Country : US
Telephone Number : 931-231-0559
Fax Number :
Provider Business Practice Location Address
First Line : 2835 HWY 231 N
Second Line : SUITE 208A
City : SHELBYVILLE
State : TN
Zip : 37160-7327
Country : US
Telephone Number : 931-231-0559
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHARLES E KELLY II
Credential : MD
Telephone Number : 931-629-9993
Provider Enumeration Date : 08/25/2008
Last Update Date : 08/25/2008

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