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General NPI Number Information
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NPI Number | 1104409663
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Entity Type | Individual
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Provider Name | KENTRICE CUNNINGHAM-LONDON
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 2341 HENRY CLOWER BLVD STE D
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City | SNELLVILLE
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State | GA
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Zip | 30078-7420
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Country | US
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Telephone | 470-406-6994
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Fax | 770-680-5324
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Provider Business Mailing Address
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Address Line | 3177 MISTY VIEW TRL
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City | LILBURN
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State | GA
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Zip | 30047-1832
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Country | US
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Telephone | 943-259-2488
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Fax | 770-680-5324
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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 | 216463
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License Number State | GA
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