Provider Demographics
NPI:1790004042
Name:ADAMS, DENISE L (RN, NP, IBCLC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RN, NP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5607
Mailing Address - Country:US
Mailing Address - Phone:770-920-2255
Mailing Address - Fax:770-920-9963
Practice Address - Street 1:6095 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5607
Practice Address - Country:US
Practice Address - Phone:770-920-2255
Practice Address - Fax:770-920-9963
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN61954163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant