Provider Demographics
NPI:1316770712
Name:TERRELL, BETH-MARIE (IBCLC)
Entity type:Individual
Prefix:
First Name:BETH-MARIE
Middle Name:
Last Name:TERRELL
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 1:3078 SAN JOSE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4508
Mailing Address - Country:US
Mailing Address - Phone:404-918-3322
Mailing Address - Fax:
Practice Address - Street 1:3078 SAN JOSE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4508
Practice Address - Country:US
Practice Address - Phone:404-918-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA304027174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty