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NPI Code Detail

MEDICARE: NORTHWEST GEORGIA ONCOLOGY CENTERS, PC

MEDICARE: NORTHWEST GEORGIA ONCOLOGY CENTERS, PC
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
1332B00000XDurable Medical Equipment & Medical Supplies0741780007GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11790813749OTHERGASUPPLIER NPI NUMBER (DOUGLASVILLE)

General Provider Information

NPI Number : 1790813749
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST GEORGIA ONCOLOGY CENTERS, PC
Provider Business Mailing Address
First Line : 1700 HOSPITAL SOUTH DR
Second Line : SUITE 300
City : AUSTELL
State : GA
Zip : 30106-6810
Country : US
Telephone Number : 770-944-2830
Fax Number : 678-581-7170
Provider Business Practice Location Address
First Line : 6002 PROFESSIONAL PKWY
Second Line : STE 220
City : DOUGLASVILLE
State : GA
Zip : 30134-5600
Country : US
Telephone Number : 678-715-9690
Fax Number : 678-581-7180
Authorized Official
Title or Position : MD PHYSICIAN
Name : DR. BRUCE J GOULD
Credential : MD
Telephone Number : 770-281-5100
Provider Enumeration Date : 03/01/2007
Last Update Date : 12/01/2010

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Directions to “NORTHWEST GEORGIA ONCOLOGY CENTERS, PC ” Practice Location

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