Healthcare Provider Details

I. General information

NPI: 1558722215
Provider Name (Legal Business Name): BREASTFEED ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 GLENRIDGE DR STE 200
ATLANTA GA
30328-5573
US

IV. Provider business mailing address

5885 GLENRIDGE DR STE 200
ATLANTA GA
30328-5573
US

V. Phone/Fax

Practice location:
  • Phone: 404-454-9715
  • Fax: 404-393-3739
Mailing address:
  • Phone: 404-454-9715
  • Fax: 404-393-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIE WARD COURSEY
Title or Position: EXECUTIVE DIRECTOR
Credential: IBCLC
Phone: 404-454-9715