1285496166 NPI number — WONDERLOVE LACTATION SERVICES

Table of content: (NPI 1285496166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285496166 NPI number — WONDERLOVE LACTATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WONDERLOVE LACTATION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285496166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2775 NORTHBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30340-4923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-449-5595
Provider Business Mailing Address Fax Number:
833-269-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1285 HEMBREE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-5715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-449-5595
Provider Business Practice Location Address Fax Number:
833-269-3532
Provider Enumeration Date:
01/26/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SARRIS
Authorized Official First Name:
SOPHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER LACTATION CONSULTANT
Authorized Official Telephone Number:
404-449-5955

Provider Taxonomy Codes

  • Taxonomy code: 163WL0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497527774 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1548776585 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".