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NPI Code Detail

MEDICARE: OFELIA S MANDOCK M.D.

MEDICARE: OFELIA S MANDOCK 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
1208000000XPediatrics Physician37447GA

General Provider Information

NPI Number : 1518962414
Entity Type Code : Individual
Provider Name (Legal Business Name) : OFELIA S MANDOCK M.D.
Provider Business Mailing Address
First Line : 1650 COUNTY SERVICES PKWY SW
Second Line :
City : MARIETTA
State : GA
Zip : 30008-4010
Country : US
Telephone Number : 770-514-2361
Fax Number : 770-514-2811
Provider Business Practice Location Address
First Line : 1650 COUNTY SERVICES PKWY SW
Second Line :
City : MARIETTA
State : GA
Zip : 30008-4010
Country : US
Telephone Number : 770-514-2361
Fax Number : 770-514-2811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/08/2007

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Directions to “ OFELIA S MANDOCK M.D.” Practice Location

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