NPIMap

Organization Active NPI

Northwest Georgia Oncology Centers, PC

  • Durable Medical Equipment & Medical Supplies
  • Villa Rica, GA
National Provider Identifier
1619005667
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
074178000 Issued in GA
Legal business name
NORTHWEST GEORGIA ONCOLOGY CENTERS, PC
Practice address
705 Dallas Hwy
Ste 205
Villa Rica, GA 30180-1247
Phone
(770) 771-5935
Fax
(770) 456-3407
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Dr. Bruce J Gould, MD
Title
MD Physician
Phone
(770) 281-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 074178000 GA Primary

Addresses

Primary practice location

705 Dallas Hwy
Ste 205
Villa Rica, GA 30180-1247

Mailing address

1700 Hospital South Dr
Suite 300
Austell, GA 30106-6810
Phone (770) 944-2830

Other identifiers 1

IdentifierTypeStateIssuer
169005667OtherGASUPPLIER NUMBER (VILLA RICA)

National Provider Directory

National Provider Directory
Tax ID family
Northwest Georgia Oncol5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1619005667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HOSPITAL SOUTH DR",
            "address_2": "SUITE 300",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066810",
            "telephone_number": "770-944-2830",
            "fax_number": "678-581-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DALLAS HWY",
            "address_2": "STE 205",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801247",
            "telephone_number": "770-771-5935",
            "fax_number": "770-456-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST GEORGIA ONCOLOGY CENTERS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MD PHYSICIAN",
        "authorized_official_telephone_number": "770-281-5100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "074178000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPPLIER NUMBER (VILLA RICA)",
            "identifier": "169005667",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.