Healthcare Provider Details

I. General information

NPI: 1750993655
Provider Name (Legal Business Name): GWINNETT BREASTFEEDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MCCLURE BRIDGE RD BUILDING C, UNIT A
DULUTH GA
30096-3461
US

IV. Provider business mailing address

3400 MCCLURE BRIDGE RD BUILDING C, UNIT A
DULUTH GA
30096-3461
US

V. Phone/Fax

Practice location:
  • Phone: 678-750-3121
  • Fax:
Mailing address:
  • Phone: 678-750-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. STACY-ANN LATOYA LOUIE
Title or Position: LACTATION CONSULTANT/OWNER
Credential: IBCLC
Phone: 678-750-3121