MEDICARE: TEQUAIDAS DIAGNOSTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1326909896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEQUAIDAS DIAGNOSTICS

Provider Business Mailing Address
First Line	:	PMB2386 3133 MAPLE DR STE 240
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	229-261-3849
Fax Number	:	478-239-5123

Provider Business Practice Location Address
First Line	:	PMB2386 3133 MAPLE DR STE 240
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	229-261-3849
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHLEBOTMIST
Name	:	MS. TEQUELLA SHAUNTA ARKADIE
Credential	:	CPT
Telephone Number	:	210-350-7012

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	12/20/2025

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