Provider Demographics
NPI:1912293101
Name:ALDRIDGE, LEAH S (JD, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:S
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:JD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 W CONWAY DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3637
Mailing Address - Country:US
Mailing Address - Phone:404-590-6455
Mailing Address - Fax:404-816-0800
Practice Address - Street 1:951 W CONWAY DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3637
Practice Address - Country:US
Practice Address - Phone:404-590-6455
Practice Address - Fax:404-816-0800
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11021907174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN