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1326042706

NPI Code Detail

MEDICARE: DR. BRUCE J GOULD MD

MEDICARE: DR. BRUCE J GOULD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	032740	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1326042706	OTHER	GA	NPI NUMBER

General Provider Information

NPI Number	:	1326042706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE J GOULD MD

Provider Business Mailing Address
First Line	:	531 ROSELANE ST NW STE 710
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-6975
Country	:	US
Telephone Number	:	678-331-3297
Fax Number	:	678-581-7187

Provider Business Practice Location Address
First Line	:	340 KENNESTONE HOSPITAL BLVD STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1158
Country	:	US
Telephone Number	:	770-281-5100
Fax Number	:	678-581-7100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/10/2019

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Directions to “ DR. BRUCE J GOULD MD” Practice Location

Language	Start Address	Practice Location

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