Provider Demographics
NPI:1225899867
Name:UPSHAW, CHINA
Entity Type:Individual
Prefix:
First Name:CHINA
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHINA
Other - Middle Name:
Other - Last Name:UPSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1393
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1006
Mailing Address - Country:US
Mailing Address - Phone:310-435-0266
Mailing Address - Fax:
Practice Address - Street 1:50 ERNEST W. BARRETT PKWY NW #4015
Practice Address - Street 2:STE 117
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066
Practice Address - Country:US
Practice Address - Phone:310-435-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management