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General NPI Number Information
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NPI Number | 1912387259
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Entity Type | Individual
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Provider Name | JORGE ISAAC PENA GARCIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 5665 PEACHTREE DUNWOODY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1764
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Country | US
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Telephone | 404-778-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 PEACOCK AVE APT 521
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City | MIAMI
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State | FL
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Zip | 33146-2868
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Country | US
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Telephone | 314-250-5394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 82533
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License Number State | GA
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