Healthcare Provider Details

I. General information

NPI: 1386517860
Provider Name (Legal Business Name): ELITE PHLEBOTMY ENTERPRISES L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 770-706-4448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAKIESHA CLOUD
Title or Position: OWNER
Credential: MA, PHLEBOTOMIST
Phone: 770-706-4448