Provider Demographics
NPI:1144830241
Name:A MOTHER'S LOVE LACTATION SERVICES
Entity type:Organization
Organization Name:A MOTHER'S LOVE LACTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE, LACTATION CONSULT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE,
Authorized Official - Phone:470-280-7059
Mailing Address - Street 1:6925 TYBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7201
Mailing Address - Country:US
Mailing Address - Phone:470-280-7059
Mailing Address - Fax:
Practice Address - Street 1:6925 TYBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7201
Practice Address - Country:US
Practice Address - Phone:470-280-7059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty