Provider Demographics
NPI:1417377086
Name:SOUTH ATLANTA LACTATION CONSULTING, LLC
Entity Type:Organization
Organization Name:SOUTH ATLANTA LACTATION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORENCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC, RLC
Authorized Official - Phone:850-774-8173
Mailing Address - Street 1:615 TRESTLE RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3421
Mailing Address - Country:US
Mailing Address - Phone:850-774-8173
Mailing Address - Fax:
Practice Address - Street 1:615 TRESTLE RD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3421
Practice Address - Country:US
Practice Address - Phone:850-774-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11197323174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty