Provider Demographics
NPI:1679861215
Name:KELSEY, TIMOTHY JR (EDS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:KELSEY
Suffix:JR
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 LAKE LAUREL RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8448
Mailing Address - Country:US
Mailing Address - Phone:478-456-7056
Mailing Address - Fax:478-454-4184
Practice Address - Street 1:524 LAKE LAUREL RD NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8448
Practice Address - Country:US
Practice Address - Phone:478-456-7056
Practice Address - Fax:478-454-4184
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator