Organization
GOODWILL MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EQUERE EYO UBOH (MANAGING DIRECTOR)
(770) 957-8144
Entity
Organization
Contact information
Practice address
903 PAVILION CT STE J, MCDONOUGH, GA 30253-6672
(770) 957-8144
(770) 957-8140
Mailing address
903 PAVILION CT STE J, MCDONOUGH, GA 30253-6672
(770) 957-8144
(770) 957-8140
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
001569
GA
Other
Enumeration date
06/26/2006
Last updated
09/14/2007
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