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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