Healthcare Provider Details

I. General information

NPI: 1760234041
Provider Name (Legal Business Name): THE LACTATION LINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE N
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL STE N
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 401-753-4841
  • Fax:
Mailing address:
  • Phone: 401-753-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KEITH KUSLAK
Title or Position: CHIEF EXECUTIVE MANAGER
Credential:
Phone: 401-753-4841