Active NPI
Lilly Marie Shupe, ATC, LAT, OTC, OT-SC
- Athletic Trainer
- Decatur, GA
National Provider Identifier
1134006182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT004124
- Practice address
- 487 Winn Way Ste 100
Decatur, GA 30030-1700 - Phone
- (404) 251-2090
- Fax
- (404) 251-4471
- NPI assigned
- Aug 20, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 24-0912 | GA | |
| Athletic Trainer | 2255A2300X | AT004124 | GA | Primary |
Addresses
Primary practice location
487 Winn Way Ste 100
Decatur, GA 30030-1700
Mailing address
487 Winn Way Ste 100
Decatur, GA 30030-1700
Phone (404) 251-2090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-0912 | GA | MD | Sports Medicine (Orthopaedic Surgery) Physician |
| AT004124 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755648000000",
"number": "1134006182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "487 WINN WAY STE 100",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301700",
"telephone_number": "404-251-2090",
"fax_number": "404-251-4471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "487 WINN WAY STE 100",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301700",
"telephone_number": "404-251-2090",
"fax_number": "404-251-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUPE",
"first_name": "LILLY",
"middle_name": "MARIE",
"credential": "ATC, LAT, OTC, OT-SC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-20",
"last_updated": "2025-08-20",
"certification_date": "2025-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "207XX0005X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "GA",
"license": "24-0912",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT004124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.