Provider Demographics
NPI:1427309871
Name:NGODDY, NWAMAKA ANWULI (OD)
Entity type:Individual
Prefix:DR
First Name:NWAMAKA
Middle Name:ANWULI
Last Name:NGODDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 BLACKTOP WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4418
Mailing Address - Country:US
Mailing Address - Phone:678-697-8503
Mailing Address - Fax:404-765-9653
Practice Address - Street 1:844 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2900
Practice Address - Country:US
Practice Address - Phone:404-460-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist