Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-46587 | GA |
NPI | 1306281472 |
---|---|
Provider Name | Alicia C Simpson |
First Address | Atlanta, GA 30306-3448 |
Second Address | Atlanta, GA 30306-3448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003137551A | (05) | GA |
202I713343 | (02) | GA |