Provider Demographics
NPI:1255017265
Name:ROBINSON, AUTUMN J (IBCLC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LAS LOMAS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3923
Mailing Address - Country:US
Mailing Address - Phone:423-596-9314
Mailing Address - Fax:
Practice Address - Street 1:502 LAS LOMAS DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3923
Practice Address - Country:US
Practice Address - Phone:423-596-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-307122174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN