Provider Demographics
NPI:1770193310
Name:SCHWARTZ, NICOLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1241 CANTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4397
Mailing Address - Country:US
Mailing Address - Phone:404-482-2578
Mailing Address - Fax:
Practice Address - Street 1:1241 CANTON ST STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4397
Practice Address - Country:US
Practice Address - Phone:404-482-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000173174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN