Marco A Ayulo Sr., MD
Individual provider Active NPI Hematology & Oncology Physician · Dublin, GA
NPI 1316938848 · NPPES record last updated Jul 10, 2023
Key facts
- NPI
- 1316938848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- 036088 (GA)
- Practice address
- 207 Fairview Park Dr
Dublin, GA 31021-2550 - Phone
- (478) 275-1111
- Fax
- (478) 488-3477
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Hematology/Oncology
- Education
- Other, 1973
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
207 Fairview Park Dr
Dublin, GA 31021-2550
Phone (478) 275-1111
Hospital & facility affiliations
- Fairview Park Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050623000009 | GA | Practitioner - Hematology/Oncology | 2466496773 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mayo Clinic Health System in Waycross, Inc. | Current |
Accepting new patients | |
| Dublin Hematology Oncology Care, PC | Current |
Accepting new patients | |
| Tift Regional Health System Inc | Current |
Accepting new patients | |
| Integrated Regional Laboratories Pathology Services, LLC | Current | Accepting new patients | |
| Tift Regional Health System Inc | Current |
Accepting new patients | |
| Mayo Clinic Health System in Waycross, Inc | Current |
Accepting new patients |
Locations
207 Fairview Park Dr
Dublin, GA 31021
Phone (478) 275-1111
901 18th St E
Tifton, GA 31794
Phone (229) 353-6208
2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 036088 | GA | Yes |
Addresses
Primary practice location
207 Fairview Park Dr
Dublin, GA 31021-2550
Mailing address
501 Riverside Dr
Waycross, GA 31501-5316
Phone (912) 283-6152
Other practice location 1
501 Riverside Dr
Waycross, GA 31501-5316
Phone (912) 283-6152
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00516612F | Medicaid | GA | |
| 00516612A | Medicaid | GA |
Other providers in Dublin, GA
- Kirk Olen Austin
- Yashica Austin
- Jennifer Averett
- Daniel Ben Avery
- Lauren Avery
- Vinilkumar Badri
- Sandra Dee Bailes
- Buffy M Bailey
- Robert Cole Bailey
- Cena Baker
All providers in Dublin, GA · Hematology & Oncology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.