Provider Demographics
NPI:1255786893
Name:GRAVLEE, MARGUERITE (BA, IBCLC)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:GRAVLEE
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CLOVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1265
Mailing Address - Country:US
Mailing Address - Phone:229-244-3393
Mailing Address - Fax:
Practice Address - Street 1:1209 CLOVER HILL RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1265
Practice Address - Country:US
Practice Address - Phone:229-244-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN