Individual provider Active NPI

Kentrice Cunningham-London

  • Phlebotomy Technician
  • Snellville, GA
National Provider Identifier
1104409663
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebotomy TechnicianTaxonomy code 246RP1900X
License
216463 Issued in GA
Practice address
2341 Henry Clower Blvd Ste D
Snellville, GA 30078-7420
Phone
(470) 406-6994
Fax
(770) 680-5324
NPI assigned
May 3, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebotomy TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 246RP1900X 216463 GA Primary

Addresses

Primary practice location

2341 Henry Clower Blvd Ste D
Snellville, GA 30078-7420

Mailing address

3177 Misty View TRL
Lilburn, GA 30047-1832
Phone (943) 259-2488

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@gomedicallabs.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Undefined Non-Physician Type (Specify)
Education
Other, 1997
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2341 Henry Clower Blvd
Suite D
Snellville, GA 30078-7420

3177 Misty View TRL
Lilburn, GA 30047-1832

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
216463GAMDPhlebotomy Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Gomedical Labs LLC Single Specialty CurrentSince Nov 24, 2025 Accepting new patients

Locations

2341 Henry Clower Blvd
Ste D
Snellville, GA 30078
Phone (470) 406-6994

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1104409663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3177 MISTY VIEW TRL",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471832",
            "telephone_number": "943-259-2488",
            "fax_number": "770-680-5324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 HENRY CLOWER BLVD STE D",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787420",
            "telephone_number": "470-406-6994",
            "fax_number": "770-680-5324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM-LONDON",
        "first_name": "KENTRICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-03",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "GA",
            "license": "216463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@gomedicallabs.com",
            "affiliation": "N",
            "endpointDescription": "Business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2341 Henry Clower Blvd Ste D",
            "city": "Snellville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300787420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

Verify at the official NPI Registry.