Healthcare Provider Details

I. General information

NPI: 1003733742
Provider Name (Legal Business Name): KATHERINE DANIELLE MCDANIEL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ENTERPRISE CT
COLUMBUS GA
31904-3090
US

IV. Provider business mailing address

22 LEE ROAD 979
PHENIX CITY AL
36870-7978
US

V. Phone/Fax

Practice location:
  • Phone: 706-576-5773
  • Fax: 706-323-4247
Mailing address:
  • Phone: 706-576-5773
  • Fax: 706-323-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-323400
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: