Individual provider Active NPI

Shanta L McKinney

  • Phlebotomy Technician
  • Duluth, GA
National Provider Identifier
1417841560
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebotomy TechnicianTaxonomy code 246RP1900X
License
L5D7K9M2 Issued in GA
Practice address
3460 Summit Ridge Pkwy Ste 402
Duluth, GA 30096-1621
Phone
(470) 760-8998
Fax
(678) 866-6909
NPI assigned
Jun 4, 2025
Last updated
Jun 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebotomy Technician 246RP1900X L5D7K9M2 GA Primary

Addresses

Primary practice location

3460 Summit Ridge Pkwy Ste 402
Duluth, GA 30096-1621

Mailing address

2854 Pleasant Oak Dr
Buford, GA 30519-8081
Phone (678) 835-8170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
L5D7K9M2GAMDPhlebotomy Technician

NPI Registry JSON

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

{
    "created_epoch": "1748995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1417841560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2854 PLEASANT OAK DR",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305198081",
            "telephone_number": "678-835-8170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 SUMMIT RIDGE PKWY STE 402",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300961621",
            "telephone_number": "470-760-8998",
            "fax_number": "678-866-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNEY",
        "first_name": "SHANTA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-04",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "GA",
            "license": "L5D7K9M2",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.