MEDICARE: DR. JOHN VINCENT MAYLOCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	064862	GA
2	207Q00000X	Family Medicine Physician	81882	SC

General Provider Information

NPI Number	:	1366413833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN VINCENT MAYLOCK M.D.

Provider Business Mailing Address
First Line	:	706 N PARRISH AVE
Second Line	:
City	:	ADEL
State	:	GA
Zip	:	31620
Country	:	US
Telephone Number	:	229-896-8000
Fax Number	:	229-896-4277

Provider Business Practice Location Address
First Line	:	1228 HIGHWAY 72 W
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1816
Country	:	US
Telephone Number	:	864-943-0549
Fax Number	:	864-227-2067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	03/28/2019

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