=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326909896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEQUAIDAS DIAGNOSTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 12/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PMB2386 3133 MAPLE DR STE 240
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-261-3849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB2386 3133 MAPLE DR STE 240
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-261-3849
-----------------------------------------------------
Fax | 478-239-5123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHLEBOTMIST
-----------------------------------------------------
Name | MS. TEQUELLA SHAUNTA ARKADIE
-----------------------------------------------------
Credential | CPT
-----------------------------------------------------
Telephone | 210-350-7012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------