Active NPI
Michael Lee Shields Jr., MAT, ATC
- Athletic Trainer
- Livingston, AL
National Provider Identifier
1437428992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1202
- Practice address
- 101 Adison Street
Livingston, AL 35470 - Phone
- (770) 880-1888
- Fax
- (205) 652-3799
- NPI assigned
- Dec 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1202 | AL | Primary |
Addresses
Primary practice location
101 Adison Street
Livingston, AL 35470
Mailing address
101 Addison Street
Livingston, AL 35470
Phone (770) 880-1888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 | Other | AL | ATHLETIC TRAINER |
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 |
|---|---|---|---|
| 1202 | AL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325116800000",
"number": "1437428992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 ADDISON STREET",
"city": "LIVINGSTON",
"state": "AL",
"postal_code": "35470",
"telephone_number": "770-880-1888",
"fax_number": "205-652-3799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 ADISON STREET",
"city": "LIVINGSTON",
"state": "AL",
"postal_code": "35470",
"telephone_number": "770-880-1888",
"fax_number": "205-652-3799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "MICHAEL",
"middle_name": "LEE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-29",
"last_updated": "2011-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "1202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "22",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livingston, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.