Healthcare Provider Details

I. General information

NPI: 1053242685
Provider Name (Legal Business Name): GOOD FRIEND TRANSPORT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630B LASSITER ST
RIVERDALE GA
30274-2417
US

IV. Provider business mailing address

630B LASSITER ST
RIVERDALE GA
30274-2417
US

V. Phone/Fax

Practice location:
  • Phone: 770-909-9393
  • Fax:
Mailing address:
  • Phone: 770-909-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: OLU ASIEGBU KALU
Title or Position: CEO
Credential:
Phone: 770-909-9393