Healthcare Provider Details

I. General information

NPI: 1619954708
Provider Name (Legal Business Name): JORGE O GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 EVANS ST SUITE A
NEWBERRY SC
29108-2939
US

IV. Provider business mailing address

2531 EVANS ST SUITE A
NEWBERRY SC
29108-2939
US

V. Phone/Fax

Practice location:
  • Phone: 803-276-7978
  • Fax: 803-675-9986
Mailing address:
  • Phone: 803-276-7978
  • Fax: 803-675-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21790
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: