NPIMap

Organization Active NPI

Otto C Goyco MD Internal Medicine LLC

  • Internal Medicine Physician
  • Cumming, GA
National Provider Identifier
1598782534
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042473 Issued in GA
Legal business name
OTTO C GOYCO MD INTERNAL MEDICINE LLC
Practice address
900 Sanders Rd
Suite B
Cumming, GA 30041-5960
Phone
(770) 781-8840
Fax
(770) 781-8098
NPI assigned
Jul 16, 2006
Last updated
Mar 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Otto C Goyco, M.D.NPI 1013990431
Title
Owner
Phone
(770) 781-8840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042473 GA Primary

Addresses

Primary practice location

900 Sanders Rd
Suite B
Cumming, GA 30041-5960

Mailing address

900 Sanders Rd
Suite B
Cumming, GA 30041-5960
Phone (770) 781-8840

Other identifiers 1

IdentifierTypeStateIssuer
000752903MMedicaidGA

National Provider Directory

National Provider Directory

Locations

1230 Bald Ridge Marina Rd
Ste G
Cumming, GA 30041
Phone (770) 781-8840

900 Sanders Rd
#B
Cumming, GA 30041
Phone (770) 781-8840

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1598782534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 SANDERS RD",
            "address_2": "SUITE B",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415960",
            "telephone_number": "770-781-8840",
            "fax_number": "770-781-8098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SANDERS RD",
            "address_2": "SUITE B",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415960",
            "telephone_number": "770-781-8840",
            "fax_number": "770-781-8098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTO C GOYCO MD INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "GOYCO",
        "authorized_official_first_name": "OTTO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-781-8840",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "042473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000752903M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.