Provider Demographics
NPI:1184764128
Name:HUPMAN, AARON J (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:J
Last Name:HUPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 ARCADO RD NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2868
Mailing Address - Country:US
Mailing Address - Phone:770-925-4200
Mailing Address - Fax:
Practice Address - Street 1:354 ARCADO RD NW
Practice Address - Street 2:SUITE 1
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2868
Practice Address - Country:US
Practice Address - Phone:770-925-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021523208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000228665AMedicaid
010001728OtherRR MEDICARE
010001728OtherRR MEDICARE