| Organization Name: | NORTHWEST GEORGIA ONCOLOGY CENTERS, PC |
| NPI Number: | 1790951788 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRUCE J GOULD (MD/ PHYSICIAN MEDICAL DIRECTOR) |
| Mailing Address: | 148 Bill Carruth Pkwy Suite 260 Hiram |
| State: | GA US |
| Postal Code: | 301413754 |
| Phone Number: | 6783631940 |
| Fax Number: | 6785817110 |
| NPI Enumeration Date: | 04/30/2008 |
| NPI Last Update Date: | 11/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 032740 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |