Provider Demographics
NPI:1699274126
Name:ATHENSBORN BIRTH SERVICES, LLC
Entity type:Organization
Organization Name:ATHENSBORN BIRTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LACTATION CONSULTANT, DOULA
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC, CLD
Authorized Official - Phone:706-223-0808
Mailing Address - Street 1:205 HARDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30648-2148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 HARDWOOD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-2148
Practice Address - Country:US
Practice Address - Phone:706-223-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-10
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty