Provider Demographics
NPI:1518047547
Name:GARCIA, ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 KINGS WAY STE E
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6905
Mailing Address - Country:US
Mailing Address - Phone:229-794-1794
Mailing Address - Fax:229-794-9794
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1121
Practice Address - Country:US
Practice Address - Phone:229-794-1794
Practice Address - Fax:229-794-9794
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00229913OtherRR MEDICARE
GA494369374AMedicaid
GA08BBRBDMedicare PIN