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NPI Code Detail

MEDICARE: DR. MALCOLM PAUL DULOCK M.D.

MEDICARE: DR. MALCOLM PAUL DULOCK 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
1174400000XSpecialist013268GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11316141302OTHERGAGROUP NPI

General Provider Information

NPI Number : 1922198647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MALCOLM PAUL DULOCK M.D.
Provider Business Mailing Address
First Line : 319 CANTON RD
Second Line :
City : CUMMING
State : GA
Zip : 30040-2213
Country : US
Telephone Number : 678-456-8200
Fax Number : 678-456-8201
Provider Business Practice Location Address
First Line : 319 CANTON RD
Second Line :
City : CUMMING
State : GA
Zip : 30040-2213
Country : US
Telephone Number : 678-456-8200
Fax Number : 678-456-8201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 11/18/2008

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