Individual
MELVIN MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 DILLON DRIVE, SPARTANBURG, SC 29307
(864) 585-2027
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4226
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042260
—
SC
01
—
P00386799
MEDICARE RAILROAD PTAN#
GA
Enumeration date
05/26/2006
Last updated
10/31/2008
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