Healthcare Provider Details

I. General information

NPI: 1750830535
Provider Name (Legal Business Name): LAKIESHA D CLOUD PHLEBOTOMIST TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAKIESHA D CLOUD MEDICAL ASSISTANT

II. Dates (important events)

Enumeration Date: 09/22/2016
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: 770-706-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: