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
200 ALLEN MEMORIAL DR, STE 302-B, BREMEN, GA 30110-2012
(770) 824-2222
(770) 824-2426
Mailing address
1700 HOSPITAL SOUTH DR, SUITE 200, 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
—
1700914926
SUPPLIER NPI NUMBER (BREMEN)
GA
Enumeration date
03/01/2007
Last updated
12/06/2010
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