Healthcare Provider Details

I. General information

NPI: 1063344505
Provider Name (Legal Business Name): MARKITA ANDERSON PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 OLD ALABAMA RD STE 625
ROSWELL GA
30076-2264
US

IV. Provider business mailing address

2151 CUMBERLAND PKWY SE APT 1228
ATLANTA GA
30339-5082
US

V. Phone/Fax

Practice location:
  • Phone: 404-985-4300
  • Fax:
Mailing address:
  • Phone: 404-985-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: