Individual
MARTHA SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
2093 HENRY TECKLENBURG DR STE 200E, CHARLESTON, SC 29414-5742
(843) 958-2500
(843) 958-2680
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TL2392
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2385PA
—
SC
Enumeration date
08/27/2015
Last updated
05/29/2024
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