| NPI | 1750376695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE J GOULD Md/ Physician 770-281-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 032740) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2011-06-01 |