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NPI Code Detail

MEDICARE: SHANNON VANN IBCLC

MEDICARE: SHANNON VANN IBCLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174N00000XLactation Consultant (Non-RN)LC000227GA

General Provider Information

NPI Number : 1013697796
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON VANN IBCLC
Provider Business Mailing Address
First Line : 1 BALTIMORE PL NW STE 160
Second Line :
City : ATLANTA
State : GA
Zip : 30308-2118
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 BALTIMORE PL NW STE 160
Second Line :
City : ATLANTA
State : GA
Zip : 30308-2118
Country : US
Telephone Number : 404-454-9715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2023
Last Update Date : 07/19/2023

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Directions to “ SHANNON VANN IBCLC” Practice Location

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