Healthcare Provider Details

I. General information

NPI: 1518849264
Provider Name (Legal Business Name): MS. LILLIAN UPSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 COLQUITT AVE STE 2
ALBANY GA
31707-5128
US

IV. Provider business mailing address

1902 COLQUITT AVE STE 2
ALBANY GA
31707-5128
US

V. Phone/Fax

Practice location:
  • Phone: 862-216-7020
  • Fax:
Mailing address:
  • Phone: 862-216-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0030044141
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: