Provider Demographics
NPI:1750064515
Name:THOMAS, MARQUITA KATRICE (CPT)
Entity type:Individual
Prefix:MS
First Name:MARQUITA
Middle Name:KATRICE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957265
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9522
Mailing Address - Country:US
Mailing Address - Phone:678-476-2060
Mailing Address - Fax:
Practice Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8627
Practice Address - Country:US
Practice Address - Phone:678-476-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20-0814Y19246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy