Provider Demographics
NPI:1497738561
Name:ADCOCK, DAVID W II (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:ADCOCK
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2876
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2876
Mailing Address - Country:US
Mailing Address - Phone:229-891-9131
Mailing Address - Fax:229-891-9079
Practice Address - Street 1:1623 OLD OCILLA RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4173
Practice Address - Country:US
Practice Address - Phone:229-891-9131
Practice Address - Fax:229-891-9079
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037460207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000596054AMedicaid
GA16BDDLJMedicare ID - Type Unspecified
GAF77806Medicare UPIN