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NPI Code Detail

MEDICARE: MALCOLM P. DULOCK, MD

MEDICARE: MALCOLM P. DULOCK, MD
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
1174400000XSpecialist013265GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GRP7624OTHERGAMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21922198647OTHERGAINDIVIDUAL NPI

General Provider Information

NPI Number : 1316141302
Entity Type Code : Organization
Provider Name (Legal Business Name) : MALCOLM P. DULOCK, MD
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 : BUSINESS MANAGER
Name : MRS. PATTI HERRICK
Credential :
Telephone Number : 678-456-8200
Provider Enumeration Date : 06/13/2007
Last Update Date : 12/04/2012

Similar Medicare Providers

1922198647 — DR. MALCOLM PAUL DULOCK M.D.
Practice Location Address:
319 CANTON RD
CUMMING, GA
30040-2213
Practice Phone: 678-456-8200
Practice Fax: 678-456-8201
1104972298 — CUMMING FAMILY PRACTICE
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1326896549 — LAUREN PALUMBO
Practice Location Address:
319 CANTON RD
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30040-2213
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1770332298 — JORDAN LACY CALVIN
Practice Location Address:
319 CANTON RD
CUMMING, GA
30040-2213
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Practice Fax:
1295575272 — SHRUTI SRIHARI
Practice Location Address:
319 CANTON RD
CUMMING, GA
30040-2213
Practice Phone: 470-239-2237
Practice Fax:

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