Provider Demographics
NPI:1851373765
Name:TOLIN, KELLIE MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:MORRIS
Last Name:TOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1500 SUNDAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5151
Mailing Address - Country:US
Mailing Address - Phone:919-322-2413
Mailing Address - Fax:919-322-2416
Practice Address - Street 1:1500 SUNDAY DR STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5151
Practice Address - Country:US
Practice Address - Phone:919-322-2413
Practice Address - Fax:919-322-2416
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-004032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2316215Medicare UPIN