Organization
MARTHA SHUPING MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA WHITLEY (CREDENTIALING MANAGER)
(704) 699-8042
Entity
Organization
Contact information
Practice address
2839 MAPLEWOOD AVE, SUITE A, WINSTON-SALEM, NC 27103-4114
(336) 745-7344
(336) 768-1857
Mailing address
PO BOX 25062, WINSTON SALEM, NC 27114-5062
(336) 745-7344
(336) 768-1857
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
32172
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5902384
—
NC
Enumeration date
07/29/2015
Last updated
07/29/2015
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