Provider Demographics
NPI:1487630554
Name:JORGE O GARCIA, M.D., LLC
Entity Type:Organization
Organization Name:JORGE O GARCIA, M.D., LLC
Other - Org Name:EMMANUEL FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-276-7978
Mailing Address - Street 1:2531 EVANS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2939
Mailing Address - Country:US
Mailing Address - Phone:803-276-7978
Mailing Address - Fax:803-675-0750
Practice Address - Street 1:2531 EVANS ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2939
Practice Address - Country:US
Practice Address - Phone:803-276-7978
Practice Address - Fax:803-675-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3499Medicaid
SCH153397371Medicare UPIN