Healthcare Provider Details

I. General information

NPI: 1881505758
Provider Name (Legal Business Name): KAYSHA UPSHAW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 THE EXCHANGE SE STE 220
ATLANTA GA
30339-2171
US

IV. Provider business mailing address

1870 THE EXCHANGE SE STE 220
ATLANTA GA
30339-2171
US

V. Phone/Fax

Practice location:
  • Phone: 678-424-4030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP004618
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: