Healthcare Provider Details

I. General information

NPI: 1740162825
Provider Name (Legal Business Name): TEQUELLA SHAUNTA ARKADIE CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 N DECATUR RD APT U2
DECATUR GA
30032-1024
US

IV. Provider business mailing address

3133 MAPLE DR NE STE 240
ATLANTA GA
30305-2509
US

V. Phone/Fax

Practice location:
  • Phone: 866-614-6930
  • Fax: 478-239-5123
Mailing address:
  • Phone: 866-614-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number11D2340581
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number25-CPT392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: