Organization
NORTHWEST GEORGIA ONCOLOGY CENTERS, PC
Active
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
15 REINHARDT COLLEGE PKWY, SUITE 110, CANTON, GA 30114-2493
(770) 720-7789
(770) 720-7784
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
—
1992833941
SUPPLIER NPI NUMBER (CANTON)
GA
Enumeration date
03/01/2007
Last updated
12/04/2012
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