Healthcare Provider Details

I. General information

NPI: 1912179466
Provider Name (Legal Business Name): CHARLES GARCIA C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 08/16/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E. KINGS HIGHWAY
EDEN NC
27288-5201
US

IV. Provider business mailing address

117 E. KINGS HIGHWAY
EDEN NC
27288-5201
US

V. Phone/Fax

Practice location:
  • Phone: 336-623-9711
  • Fax: 336-623-7660
Mailing address:
  • Phone: 336-623-9711
  • Fax: 336-623-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number021236
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: