Provider Demographics
NPI:1649450156
Name:NORTHWEST GEORGIA E.N.T. INC.
Entity type:Organization
Organization Name:NORTHWEST GEORGIA E.N.T. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-606-8900
Mailing Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2154
Mailing Address - Country:US
Mailing Address - Phone:770-606-8900
Mailing Address - Fax:770-606-9002
Practice Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 202
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2154
Practice Address - Country:US
Practice Address - Phone:770-606-8900
Practice Address - Fax:770-606-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE03639Medicare UPIN