MEDICARE: LADYBUG LACTATION LLC.

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	:	1588519037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADYBUG LACTATION LLC.

Provider Business Mailing Address
First Line	:	PO BOX 8
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-0008
Country	:	US
Telephone Number	:	470-256-5777
Fax Number	:	678-623-8889

Provider Business Practice Location Address
First Line	:	225 MAIN ST UNIT 8
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-6100
Country	:	US
Telephone Number	:	470-256-5777
Fax Number	:	678-623-8889

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA FAITH ANDERSON CLACKUM
Credential	:	IBCLC
Telephone Number	:	470-256-5777

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/04/2026

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