Healthcare Provider Details

I. General information

NPI: 1487611935
Provider Name (Legal Business Name): PAUL GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E 12TH ST
WASHINGTON NC
27889-3409
US

IV. Provider business mailing address

628 E 12TH ST
WASHINGTON NC
27889-3409
US

V. Phone/Fax

Practice location:
  • Phone: 252-975-4100
  • Fax: 252-948-4829
Mailing address:
  • Phone: 252-975-4100
  • Fax: 252-948-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200300342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: