MEDICARE: MS. MARQUITA KATRICE THOMAS CPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	20-0814Y19	GA

General Provider Information

NPI Number	:	1750064515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARQUITA KATRICE THOMAS CPT

Provider Business Mailing Address
First Line	:	PO BOX 957265
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30095-9522
Country	:	US
Telephone Number	:	678-476-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 105
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8627
Country	:	US
Telephone Number	:	678-476-2060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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