Provider Demographics
NPI:1922198647
Name:DULOCK, MALCOLM PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:PAUL
Last Name:DULOCK
Suffix:
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 1:319 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2213
Mailing Address - Country:US
Mailing Address - Phone:678-456-8200
Mailing Address - Fax:678-456-8201
Practice Address - Street 1:319 CANTON RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2213
Practice Address - Country:US
Practice Address - Phone:678-456-8200
Practice Address - Fax:678-456-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1316141302OtherGROUP NPI
GA1316141302OtherGROUP NPI
GA08CBBJVMedicare PIN