Most Relevant Information
Provider Data
| NPI Number: | 1003218520 |
| Provider Name: | LEAH SHUPE PAC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN214000 |
Most Important Dates
| Enumeration Date: | 09/16/2014 |
| Last Updated: | 06/12/2020 |
Provider Practice Location
2045 HIGHWAY 34 E
NEWNAN
GA
302651327
Practice Location Phone/Fax
| Phone: | 7705020202 |
| Fax: | 7705028822 |
Provider Mailing Location
835 COGBURN AVE NW STE 250
MARIETTA
GA
300601056
Provider Mailing Phone/Fax
| Phone: | 7704225557 |
| Fax: | 7704228816 |