Provider Demographics
NPI:1699396903
Name:MBADUGHA, HILARY JACK
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:JACK
Last Name:MBADUGHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11348 TARA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6277
Mailing Address - Country:US
Mailing Address - Phone:678-519-3399
Mailing Address - Fax:678-519-3404
Practice Address - Street 1:11348 TARA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6277
Practice Address - Country:US
Practice Address - Phone:678-519-3399
Practice Address - Fax:678-519-3404
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist