Healthcare Provider Details

I. General information

NPI: 1831212919
Provider Name (Legal Business Name): AMY BETH SHOEMAKER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 J DEWEY GRAY CIR SUITE 308
AUGUSTA GA
30909-6584
US

IV. Provider business mailing address

3624 J DEWEY GRAY CIR SUITE 308
AUGUSTA GA
30909-6584
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-7529
  • Fax: 706-312-7610
Mailing address:
  • Phone: 706-210-7529
  • Fax: 706-312-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: