Organization
NORTHWEST GEORGIA ONCOLOGY CENTERS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE J GOULD MD (MD/ PHYSICIAN MEDICAL DIRECTOR)
(770) 281-5100
Entity
Organization
Contact information
Practice address
148 BILL CARRUTH PKWY, SUITE 260, HIRAM, GA 30141-3754
(678) 363-1940
(678) 581-7110
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
032740
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790951788
SUPPLIER NPI NUMBER (HIRAM)
GA
Enumeration date
04/30/2008
Last updated
11/24/2010
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