Organization
APPLACHAIN PAIN THERAPY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSIAH KELLEY LILLY MD (OWNER)
(304) 925-2922
Entity
Organization
Contact information
Practice address
4407 MACCORKLE AVE SE, CHARLESTON, WV 25304-2505
(304) 925-2922
(304) 926-8009
Mailing address
4407 MACCORKLE AVE SE, CHARLESTON, WV 25304-2505
(304) 925-2922
(304) 926-8009
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
11322
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0201994000
—
WV
Enumeration date
03/29/2007
Last updated
10/24/2007
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