Organization
OTTO C GOYCO MD INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OTTO C GOYCO M.D. (OWNER)
(770) 781-8840
Entity
Organization
Contact information
Practice address
900 SANDERS RD, SUITE B, CUMMING, GA 30041-5960
(770) 781-8840
(770) 781-8098
Mailing address
900 SANDERS RD, SUITE B, CUMMING, GA 30041-5960
(770) 781-8840
(770) 781-8098
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042473
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000752903M
—
GA
Enumeration date
07/16/2006
Last updated
03/09/2011
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