Healthcare Provider Details

I. General information

NPI: 1487163341
Provider Name (Legal Business Name): KIANA PATRICE AYERS LACTATION CONSULTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 09/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 WINDING WOODS LN
JONESBORO GA
30236-3300
US

IV. Provider business mailing address

2045 MOUNT ZION RD STE 200
MORROW GA
30260-3313
US

V. Phone/Fax

Practice location:
  • Phone: 678-815-6201
  • Fax:
Mailing address:
  • Phone: 678-815-6201
  • Fax: 678-846-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN156524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: