Healthcare Provider Details

I. General information

NPI: 1659111524
Provider Name (Legal Business Name): LIQUID GOLD SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 KELVINGTON WAY SW
LILBURN GA
30047
US

IV. Provider business mailing address

113 S. PERRY STREET SUITE 206 #9313
LAWRENCEVILLE GA
30046-4811
US

V. Phone/Fax

Practice location:
  • Phone: 678-712-8582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COURTNEY STALLWORTH
Title or Position: CEO
Credential: BSN RN IBCLC
Phone: 678-712-8582