Healthcare Provider Details

I. General information

NPI: 1326909896
Provider Name (Legal Business Name): TEQUAIDAS DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PMB2386 3133 MAPLE DR STE 240
ATLANTA GA
30305
US

IV. Provider business mailing address

PMB2386 3133 MAPLE DR STE 240
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 229-261-3849
  • Fax:
Mailing address:
  • Phone: 229-261-3849
  • Fax: 478-239-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. TEQUELLA SHAUNTA ARKADIE
Title or Position: OWNER/PHLEBOTMIST
Credential: CPT
Phone: 210-350-7012