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General NPI Number Information
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NPI Number | 1063217206
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Entity Type | Individual
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Provider Name | KENDRA CRUICKSHANK
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 3576 COVINGTON HWY # 103
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City | DECATUR
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State | GA
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Zip | 30032-1834
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Country | US
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Telephone | 470-518-6287
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Fax | 470-275-0684
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Provider Business Mailing Address
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Address Line | 3576 COVINGTON HWY STE 103
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City | DECATUR
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State | GA
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Zip | 30032-1834
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Country | US
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Telephone | 470-518-6287
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Fax | 470-275-0684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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