MEDICARE: LEIA EUBANKS GIDDENS 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
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1427771880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIA EUBANKS GIDDENS IBCLC

Provider Business Mailing Address
First Line	:	607 DOGWOOD DR
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-8418
Country	:	US
Telephone Number	:	478-457-7278
Fax Number	:	478-254-9157

Provider Business Practice Location Address
First Line	:	528 SPARTA RD
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1859
Country	:	US
Telephone Number	:	478-457-7278
Fax Number	:	478-254-9157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	03/12/2026

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