Individual
DR. MELVIN DANA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11685 ALPHARETTA HWY, SUITE 320, ROSWELL, GA 30076-4913
(770) 442-5882
(470) 514-3759
Mailing address
11685 ALPHARETTA HWY, SUITE 320, ROSWELL, GA 30076-4913
(770) 442-5882
(470) 514-3759
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
063638
GA
207R00000X
Internal Medicine Physician
ME105404
FL
207RG0100X
Gastroenterology Physician
Primary
63638
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003101130D
—
GA
05
—
003101130E
—
GA
01
—
146KW
BC/BS
FL
01
—
P00782776
RR MEDICARE
FL
Enumeration date
01/22/2007
Last updated
03/04/2020
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