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NPI Code Detail

MEDICARE: MARINA ELEA GARCIA MACK BS

MEDICARE: MARINA ELEA GARCIA MACK BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystLBA000767GA

General Provider Information

NPI Number : 1114531050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA ELEA GARCIA MACK BS
Provider Business Mailing Address
First Line : 225 SMITHVILLE CHURCH RD STE 1100
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-9097
Country : US
Telephone Number : 800-832-9419
Fax Number :
Provider Business Practice Location Address
First Line : 225 SMITHVILLE CHURCH RD STE 1100
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-9097
Country : US
Telephone Number : 800-832-9419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2020
Last Update Date : 05/21/2026

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