Provider Demographics
NPI:1275374399
Name:GODBY MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:GODBY MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMARICKO MALVIN
Authorized Official - Middle Name:MALVIN
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:678-859-3303
Mailing Address - Street 1:2245 GODBY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5059
Mailing Address - Country:US
Mailing Address - Phone:678-859-3303
Mailing Address - Fax:
Practice Address - Street 1:2245 GODBY RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5059
Practice Address - Country:US
Practice Address - Phone:678-859-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty