Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-303750 |
NPI | 1346910882 |
---|---|
Provider Name | Candace L Green |
First Address | Martinez, GA 30907-1391 |
Second Address | Augusta, GA 30909-1807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 29/09/2021 |