Provider Demographics
NPI:1225511355
Name:FLETCHER, AMY (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7742 SPALDING DR # 122
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4207
Mailing Address - Country:US
Mailing Address - Phone:678-786-7770
Mailing Address - Fax:
Practice Address - Street 1:5243 AMHURST DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-1621
Practice Address - Country:US
Practice Address - Phone:678-786-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000120163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant