Provider Demographics
NPI:1033758610
Name:NOURISHED YOUNG, LLC
Entity Type:Organization
Organization Name:NOURISHED YOUNG, LLC
Other - Org Name:INTOWN LACTATION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:404-406-6436
Mailing Address - Street 1:635 GRANT ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3146
Mailing Address - Country:US
Mailing Address - Phone:404-406-6436
Mailing Address - Fax:
Practice Address - Street 1:178 LAREDO DR STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2206
Practice Address - Country:US
Practice Address - Phone:404-333-8658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALC000029OtherLACTATION CONSULTING