MEDICARE: LACTATION CONSULTANTS OF ATLANTA

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
1	163WL0100X	Lactation Consultant (Registered Nurse)	RN027027	GA

General Provider Information

NPI Number	:	1144627746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACTATION CONSULTANTS OF ATLANTA

Provider Business Mailing Address
First Line	:	2024 POWERS FERRY RD SE STE 201
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5011
Country	:	US
Telephone Number	:	770-644-0555
Fax Number	:	770-644-0514

Provider Business Practice Location Address
First Line	:	2024 POWERS FERRY RD SE STE 201
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5011
Country	:	US
Telephone Number	:	770-644-0555
Fax Number	:	770-644-0514

Authorized Official
Title or Position	:	OWNER/ CEO
Name	:	MRS. SHARON A BIRDSEYE
Credential	:	RN, IBCLC
Telephone Number	:	770-644-0555

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/25/2014

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