Provider Demographics
NPI:1457508160
Name:CHARLES E KELLY II MD
Entity Type:Organization
Organization Name:CHARLES E KELLY II MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:931-629-9993
Mailing Address - Street 1:2835 HWY 231 N
Mailing Address - Street 2:SUITE 208A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-7327
Mailing Address - Country:US
Mailing Address - Phone:931-231-0559
Mailing Address - Fax:
Practice Address - Street 1:2835 HWY 231 N
Practice Address - Street 2:SUITE 208A
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7327
Practice Address - Country:US
Practice Address - Phone:931-231-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty