Provider Demographics
NPI:1487841672
Name:JOACHIM O NWAGWU
Entity Type:Organization
Organization Name:JOACHIM O NWAGWU
Other - Org Name:RELIABLE MEDICAL SUPPLY OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOACHIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:770-944-3805
Mailing Address - Street 1:4385 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8202
Mailing Address - Country:US
Mailing Address - Phone:770-944-3805
Mailing Address - Fax:770-944-3806
Practice Address - Street 1:4385 STONECREST DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8202
Practice Address - Country:US
Practice Address - Phone:770-944-3805
Practice Address - Fax:770-944-3806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4816910001Medicare NSC