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Individual
LILLY MARIE SHUPE
Active
Individual
LILLY MARIE SHUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT, OTC, OT-SC
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
24-0912
GA
2255A2300X
Athletic Trainer
Primary
AT004124
GA
Other
Enumeration date
08/20/2025
Last updated
08/20/2025
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