Healthcare Provider Details

I. General information

NPI: 1750275616
Provider Name (Legal Business Name): MS. KATELYN HOPE SHEPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 RIVER RD
ATHENS GA
30602-1538
US

IV. Provider business mailing address

1425 WOODLAND LAKE DR
SNELLVILLE GA
30078-2097
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-5060
  • Fax:
Mailing address:
  • Phone: 404-247-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: