Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 326678 | GA |
NPI | 1043803448 |
---|---|
Provider Name | Brooke Frederick |
First Address | Rossville, GA 30741-8375 |
Second Address | Rossville, GA 30741-8375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2021 |
Last Update Date | 13/03/2021 |