Individual
AMANDA ROSE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLC
Contact information
Practice address
216 SARA BETH DR, BROOKLET, GA 30415-8212
(912) 690-3144
Mailing address
216 SARA BETH DR, BROOKLET, GA 30415-8212
(912) 690-3144
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
ALPP207699
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALPP207699
ACADEMY OF LACTATION
—
Enumeration date
11/06/2017
Last updated
11/06/2017
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