Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1134773880 |
---|---|
Provider Name | Heather Michelle Goodbread |
First Address | Atlanta, GA 30308-2118 |
Second Address | Roswell, GA 30075-4976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2019 |
Last Update Date | 31/07/2019 |