Provider Demographics
NPI:1891505756
Name:BLOOM AND GROW LACTATION
Entity type:Organization
Organization Name:BLOOM AND GROW LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-672-1381
Mailing Address - Street 1:126 SUMMER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8630
Mailing Address - Country:US
Mailing Address - Phone:601-672-1381
Mailing Address - Fax:
Practice Address - Street 1:272 S PERKINS ST STE 200
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2730
Practice Address - Country:US
Practice Address - Phone:601-521-3196
Practice Address - Fax:601-510-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service