Alexander Shupp PA-C

NPI 1457740664 - Physician Assistant - 363A00000X

NPI Details
NPI 1457740664
Gender Male
Enumeration Date 01/12/2015
Last Updated 01/12/2015
Entity Type Individual
Active Over 1 year ago
Practice Location
801 W GORDON ST
THOMASTON GA, 30286-3426, US
Phone (706) 647-8111
Fax
Business Location
301 BARRINGTON HALL DR APT 814
MACON GA, 31220-0734, US
Phone
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Georgia
License Number 7471
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According to our database, Mr. Alexander Shupp PA-C NPI is 1457740664, taxonomy code is 363A00000X and license number is 7471, license state is located at Georgia. Alexander Shupp PA-C physically located at 801 W Gordon St, Thomaston GA, 30286-3426. NPI Number Alexander Shupp PA-C has the Individual type.

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1457740664 NPI number is provided on an as is basis without warranty of any kind. 1457740664 is maintained by the National Plan & Provider Enumeration System. The contents of Alexander Shupp PA-C are for informational purposes only.