Organization
CHARLES E.KELLY & COMPANY
Active
Parent organization
GLENVILLE BANK
Other names
TIPPIN BANK & TRUST COMPANY
Organization subpart
Yes
Provider details
NPI number
Legal business name
GLENVILLE BANK
Authorized official
MR. CHARLES E KELLY SR. DOC (MARKET COMMUNICATION SPECIALIST)
(912) 739-1122
Entity
Organization
Contact information
Practice address
409 OAK ST, CLAXTON, GA 30417-1351
(912) 739-1122
Mailing address
409 OAK ST, CLAXTON, GA 30417-1351
(912) 739-1122
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
GA
251B00000X
Case Management Agency
—
GA
251S00000X
Community/Behavioral Health Agency
—
GA
305R00000X
Preferred Provider Organization
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1399374
GATEWAY AUTHORITY
GA
Enumeration date
12/03/2014
Last updated
12/03/2014
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