=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639799372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN G HOWINGTON IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2020
-----------------------------------------------------
Last Update Date | 04/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4520 BARTOW CARVER RD SE APT 3
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30102-2669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-289-6129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4520 BARTOW CARVER RD SE APT 3
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30102-2669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-289-6129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number | LC000181
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------