Provider Demographics
NPI:1912238619
Name:VILLA-GARCIA, PABLO RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:RAMON
Last Name:VILLA-GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4897 BUFORD HWY
Mailing Address - Street 2:SUITE # 167
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3667
Mailing Address - Country:US
Mailing Address - Phone:770-452-5642
Mailing Address - Fax:770-452-5643
Practice Address - Street 1:4897 BUFORD HWY
Practice Address - Street 2:SUITE # 167
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3667
Practice Address - Country:US
Practice Address - Phone:770-452-5642
Practice Address - Fax:770-452-5643
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA056781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA458496371AMedicaid