Individual
SHELBY BROUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, OTC
Contact information
Practice address
1968 HAWKS LN NE, BROOKHAVEN, GA 30329-2283
(404) 778-7137
Mailing address
8308 DRUID HILLS RESERVE DR NE, ATLANTA, GA 30329-2064
(336) 602-3115
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000029173
BOC ATHLETIC TRAINING
—
Enumeration date
02/25/2021
Last updated
02/25/2021
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