Provider Demographics
NPI:1831212919
Name:SHOEMAKER, AMY BETH (ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6584
Mailing Address - Country:US
Mailing Address - Phone:706-210-7529
Mailing Address - Fax:706-312-7610
Practice Address - Street 1:3624 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 308
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6584
Practice Address - Country:US
Practice Address - Phone:706-210-7529
Practice Address - Fax:706-312-7610
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer