Individual
TIMOTHY WHITE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED ATC-L
Contact information
Practice address
9502 PROVIDENCE RD, CHARLOTTE, NC 28277-8695
(704) 846-7219
(704) 846-7219
Mailing address
9502 PROVIDENCE RD, CHARLOTTE, NC 28277-8695
(704) 846-7219
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1403
NC
Other
Enumeration date
08/02/2017
Last updated
08/02/2017
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