MEDICARE: JULIE CHAMPEAU LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1154138329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE CHAMPEAU LLC

Provider Business Mailing Address
First Line	:	959 HALL PL NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4963
Country	:	US
Telephone Number	:	863-255-3293
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 HALL PL NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4963
Country	:	US
Telephone Number	:	863-255-3293
Fax Number	:

Authorized Official
Title or Position	:	LACTATION CONSULTANT/OWNER
Name	:	JULIE ELIZABETH CHAMPEAU
Credential	:	MOT, OTR/L, IBCLC
Telephone Number	:	863-255-3293

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/27/2024

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