Provider Demographics
NPI:1942393327
Name:GARCIA, GERMAN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:GERMAN
Middle Name:JOSE
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 1:1143 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4172
Mailing Address - Country:US
Mailing Address - Phone:706-229-9501
Mailing Address - Fax:
Practice Address - Street 1:1143 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4172
Practice Address - Country:US
Practice Address - Phone:706-229-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053528207R00000X
GA53528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA342515362BMedicaid
GA342515362AMedicaid