Provider Demographics
NPI:1487283867
Name:GEORGE, CHARLOTTE KELSEY
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:KELSEY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1469
Mailing Address - Country:US
Mailing Address - Phone:813-236-5350
Mailing Address - Fax:813-236-5303
Practice Address - Street 1:5802 N 30TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1469
Practice Address - Country:US
Practice Address - Phone:813-236-5350
Practice Address - Fax:813-236-5303
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine