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General NPI Number Information
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NPI Number | 1659111524
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Entity Type | Organization
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Legal Business Name | LIQUID GOLD SOLUTIONS
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1231 KELVINGTON WAY SW
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City | LILBURN
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State | GA
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Zip | 30047
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Country | US
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Telephone | 678-712-8582
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Fax |
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Provider Business Mailing Address
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Address Line | 113 S. PERRY STREET SUITE 206 #9313
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4811
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | COURTNEY STALLWORTH
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Credential | BSN RN IBCLC
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Telephone | 678-712-8582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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