MEDICARE: KENDRA CRUICKSHANK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1063217206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA CRUICKSHANK

Provider Business Mailing Address
First Line	:	3576 COVINGTON HWY STE 103
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1834
Country	:	US
Telephone Number	:	470-518-6287
Fax Number	:	470-275-0684

Provider Business Practice Location Address
First Line	:	3576 COVINGTON HWY # 103
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1834
Country	:	US
Telephone Number	:	470-518-6287
Fax Number	:	470-275-0684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	12/19/2025

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Directions to “ KENDRA CRUICKSHANK ” Practice Location

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