=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457970790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRIE BIRTH EXPERIENCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2020
-----------------------------------------------------
Last Update Date | 04/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13988 SUNFISH BND
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-0605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-915-4348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13988 SUNFISH BND
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-0605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-915-4348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LABOR DOULA / CHILDBIRTH EDUCATOR
-----------------------------------------------------
Name | KINDLE-SIMONE FRIEDLANDER
-----------------------------------------------------
Credential | CLD, CCCE
-----------------------------------------------------
Telephone | 404-915-4348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------