Provider Demographics
NPI:1285496166
Name:WONDERLOVE LACTATION SERVICES
Entity Type:Organization
Organization Name:WONDERLOVE LACTATION SERVICES
Other - Org Name:WONDERLOVE LACTATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN IBCLC
Authorized Official - Phone:404-449-5955
Mailing Address - Street 1:2775 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4923
Mailing Address - Country:US
Mailing Address - Phone:404-449-5595
Mailing Address - Fax:833-269-3532
Practice Address - Street 1:1285 HEMBREE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5715
Practice Address - Country:US
Practice Address - Phone:404-449-5595
Practice Address - Fax:833-269-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1497527774OtherINDIVIDUAL NPI
GA1548776585OtherINDIVIDUAL NPI