Individual
MR. MICHAEL LEE SHIELDS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAT, ATC
Contact information
Practice address
101 ADISON STREET, LIVINGSTON, AL 35470
(770) 880-1888
(205) 652-3799
Mailing address
101 ADDISON STREET, LIVINGSTON, AL 35470
(770) 880-1888
(205) 652-3799
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1202
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
ATHLETIC TRAINER
AL
Enumeration date
12/29/2011
Last updated
12/29/2011
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