Provider Demographics
NPI:1982652467
Name:GOODHEALTH MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:GOODHEALTH MEDICAL SUPPLIES, INC.
Other - Org Name:GWINNETT MEDICAL SUPPLY, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:U
Authorized Official - Last Name:OGBUAGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-963-3800
Mailing Address - Street 1:223 SCENIC HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5603
Mailing Address - Country:US
Mailing Address - Phone:770-963-3800
Mailing Address - Fax:770-963-3860
Practice Address - Street 1:223 SCENIC HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5603
Practice Address - Country:US
Practice Address - Phone:770-963-3800
Practice Address - Fax:770-963-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA14322640AMedicaid
5706170001Medicare ID - Type Unspecified