Provider Demographics
NPI:1013125061
Name:GRIDER, ANNE DOLORES (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:DOLORES
Last Name:GRIDER
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2743
Mailing Address - Country:US
Mailing Address - Phone:770-516-6754
Mailing Address - Fax:
Practice Address - Street 1:3979 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2743
Practice Address - Country:US
Practice Address - Phone:770-516-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN