Individual
MELVIN DUBOSE MEDLOCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2934 N ELM ST STE E, LUMBERTON, NC 28358-2987
(910) 739-0022
(910) 739-0079
Mailing address
5221 PARAMOUNT PKWY STE 220, MORRISVILLE, NC 27560-5490
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
058287
GA
208600000X
Surgery Physician
Primary
2015-01793
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NCO905A
MEDICARE PTAN
NC
Enumeration date
05/23/2005
Last updated
03/01/2024
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