Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1043982044 |
---|---|
Provider Name | Sharva Pruitt |
First Address | Lagrange, GA 30241-9504 |
Second Address | Lagrange, GA 30241-9504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2021 |
Last Update Date | 29/09/2021 |