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General NPI Number Information
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NPI Number | 1649450156
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Entity Type | Organization
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Legal Business Name | NORTHWEST GEORGIA E.N.T. INC.
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 962 JOE FRANK HARRIS PKWY SE SUITE 202
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2154
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Country | US
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Telephone | 770-606-8900
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Fax | 770-606-9002
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Provider Business Mailing Address
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Address Line | 962 JOE FRANK HARRIS PKWY SE SUITE 202
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2154
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Country | US
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Telephone | 770-606-8900
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Fax | 770-606-9002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY EUGENE GOFF
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Credential | M.D.
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Telephone | 770-606-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 43944
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License Number State | GA
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