Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-12194 | GA |
NPI | 1194386201 |
---|---|
Provider Name | Mrs. Pamela Juliet Campbell |
First Address | Peachtree City, GA 30269-1861 |
Second Address | Peachtree City, GA 30269-1861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |