Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1013125061 |
---|---|
Provider Name | Anne Dolores Grider |
First Address | Marietta, GA 30066-2743 |
Second Address | Marietta, GA 30066-2743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 11/05/2011 |