Provider Demographics
NPI:1144627746
Name:LACTATION CONSULTANTS OF ATLANTA
Entity type:Organization
Organization Name:LACTATION CONSULTANTS OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIRDSEYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:770-644-0555
Mailing Address - Street 1:2024 POWERS FERRY RD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5011
Mailing Address - Country:US
Mailing Address - Phone:770-644-0555
Mailing Address - Fax:770-644-0514
Practice Address - Street 1:2024 POWERS FERRY RD SE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5011
Practice Address - Country:US
Practice Address - Phone:770-644-0555
Practice Address - Fax:770-644-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN027027163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty