Healthcare Provider Details

I. General information

NPI: 1356205132
Provider Name (Legal Business Name): LOLA SUNSHINE THOMAS L-320926
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEW ST UNIT 1202
DECATUR GA
30030-4254
US

IV. Provider business mailing address

PO BOX 3550
DECATUR GA
30031-3550
US

V. Phone/Fax

Practice location:
  • Phone: 845-662-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN248793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: