Provider Demographics
NPI:1407315245
Name:GOODNESS NUTRITION CENTER, LLC
Entity Type:Organization
Organization Name:GOODNESS NUTRITION CENTER, LLC
Other - Org Name:GOODNESS NUTRITION CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:AMPARO
Authorized Official - Last Name:OCHOA-ANDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-680-3261
Mailing Address - Street 1:761 ROSA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6613
Mailing Address - Country:US
Mailing Address - Phone:678-680-3261
Mailing Address - Fax:770-852-8648
Practice Address - Street 1:761 ROSA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6613
Practice Address - Country:US
Practice Address - Phone:678-680-3261
Practice Address - Fax:833-441-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty