Provider Demographics
NPI:1558890624
Name:SANDERS, KATHRYN COOK (IBCLC, CLC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:COOK
Last Name:SANDERS
Suffix:
Gender:F
Credentials:IBCLC, CLC
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:SANDERS
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC, CLC
Mailing Address - Street 1:3920 GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7212
Mailing Address - Country:US
Mailing Address - Phone:404-593-8719
Mailing Address - Fax:
Practice Address - Street 1:3920 GROVE TRL
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7212
Practice Address - Country:US
Practice Address - Phone:404-593-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000015174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN