Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L 16318 | GA |
NPI | 1003211079 |
---|---|
Provider Name | Mrs. Melissa Brice |
First Address | Dallas, GA 30157 |
Second Address | Dallas, GA 30157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2014 |
Last Update Date | 03/11/2014 |