Shelby Broughton, ATC, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1968 Hawks LN NE
Brookhaven, GA 30329-2283

Phone

(404) 778-7137

NPI assigned

Feb 25, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1922692300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8308 DRUID HILLS RESERVE DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292064",
            "telephone_number": "336-602-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 HAWKS LN NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303292283",
            "telephone_number": "404-778-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUGHTON",
        "first_name": "SHELBY",
        "credential": "ATC, OTC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOC ATHLETIC TRAINING",
            "identifier": "2000029173",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sabroug@emory.edu",
            "affiliation": "N",
            "endpointDescription": "secure work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1968 Hawks Ln NE",
            "city": "Brookhaven",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303292283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Keisha Renee Brooks
• Lapachus Tacorra-Samone Brooks, BS
• Charlene Brown
• Cinnamon Brown
• Elizabeth Brown
• Kiana Brown, RBT
• M. D. Brown, PH.D, LPC, NCC, CPSC

• Athletic Trainer in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.