Healthcare Provider Details

I. General information

NPI: 1346433521
Provider Name (Legal Business Name): ANDREA GARCIA ALEXANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA GARCIA WADDELL MD

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/07/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N WILEY AVE
DONALSONVILLE GA
39845-1120
US

IV. Provider business mailing address

804 N WILEY AVE
DONALSONVILLE GA
39845-1120
US

V. Phone/Fax

Practice location:
  • Phone: 229-524-2808
  • Fax: 229-524-1272
Mailing address:
  • Phone: 229-524-2808
  • Fax: 229-524-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number060626
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: