Provider Demographics
NPI:1104409663
Name:CUNNINGHAM-LONDON, KENTRICE
Entity type:Individual
Prefix:
First Name:KENTRICE
Middle Name:
Last Name:CUNNINGHAM-LONDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3177 MISTY VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1832
Mailing Address - Country:US
Mailing Address - Phone:943-259-2488
Mailing Address - Fax:770-680-5324
Practice Address - Street 1:2341 HENRY CLOWER BLVD STE D
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7420
Practice Address - Country:US
Practice Address - Phone:470-406-6994
Practice Address - Fax:770-680-5324
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA216463246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty