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: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 N. DECATUR RD. APT U2
DECATUR GA
30032
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 770-376-7229
  • Fax:
Mailing address:
  • Phone: 770-376-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. TEQUELLA SHAUNTA ARKADIE
Title or Position: OWNER/PHLEBOTMIST
Credential: CPT
Phone: 720-288-0439