Healthcare Provider Details

I. General information

NPI: 1285496166
Provider Name (Legal Business Name): WONDERLOVE LACTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 HEMBREE RD STE 100
ROSWELL GA
30076-5715
US

IV. Provider business mailing address

2775 NORTHBROOK DR
ATLANTA GA
30340-4923
US

V. Phone/Fax

Practice location:
  • Phone: 404-449-5595
  • Fax: 833-269-3532
Mailing address:
  • Phone: 404-449-5595
  • Fax: 833-269-3532

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: SOPHIA K SARRIS
Title or Position: OWNER LACTATION CONSULTANT
Credential: RN BSN IBCLC
Phone: 404-449-5955