Organization
NORTHWEST GEORGIA ONCOLOGY CENTERS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE J GOULD MD (MD PHYSICIAN)
(770) 281-5100
Entity
Organization
Contact information
Practice address
705 DALLAS HWY, STE 205, VILLA RICA, GA 30180-1247
(770) 771-5935
(770) 456-3407
Mailing address
1700 HOSPITAL SOUTH DR, SUITE 300, AUSTELL, GA 30106-6810
(770) 944-2830
(678) 581-7170
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
074178000
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169005667
SUPPLIER NUMBER (VILLA RICA)
GA
Enumeration date
03/01/2007
Last updated
12/09/2010
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