Provider Demographics
NPI:1588256382
Name:RIDLEY, MEGAN (IBCLC-RLC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:IBCLC-RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 HEAVENS WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721
Mailing Address - Country:US
Mailing Address - Phone:706-264-0760
Mailing Address - Fax:
Practice Address - Street 1:418 HEAVENS WAY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-3072
Practice Address - Country:US
Practice Address - Phone:706-264-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000216174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN