Healthcare Provider Details

I. General information

NPI: 1447190426
Provider Name (Legal Business Name): ANEKA MCCUTCHEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 JOHNS CREEK PKWY # B
SUWANEE GA
30024-6038
US

IV. Provider business mailing address

1695 MILLSIDE TER
DACULA GA
30019-3259
US

V. Phone/Fax

Practice location:
  • Phone: 770-526-0963
  • Fax:
Mailing address:
  • Phone: 573-433-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN103461
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: