Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-151124 | GA |
NPI | 1194385054 |
---|---|
Provider Name | Laura Crockett |
First Address | Atlanta, GA 30306-3712 |
Second Address | Atlanta, GA 30306-3712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2019 |
Last Update Date | 13/06/2019 |