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
340 KENNESTONE HOSPITAL BLVD, SUITE 200, MARIETTA, GA 30060-1121
(770) 281-5100
(678) 581-7100
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
174400000X
Specialist
Primary
032740
GA
333600000X
Pharmacy
—
GA
3336C0003X
Community/Retail Pharmacy
—
GA
3336S0011X
Specialty Pharmacy
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028463A
—
GA
01
—
GRP245
GROUP PTAN
GA
Enumeration date
09/16/2005
Last updated
06/01/2011
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