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General NPI Number Information
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NPI Number | 1396895033
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Entity Type | Individual
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Provider Name | BRADFORD M GOULD M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 2878 FIVE FORKS TRICKUM RD 2A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5896
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Country | US
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Telephone | 678-344-8700
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Fax | 678-344-8600
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Provider Business Mailing Address
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Address Line | 2878 FIVE FORKS TRICKUM RD # 2A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5896
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Country | US
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Telephone | 678-344-8700
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Fax | 678-344-8600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 050712
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License Number State | GA
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