MEDICARE: DR. MARIO ANTONIO GARCIA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	T-4850	MS
2	207R00000X	Internal Medicine Physician	5692	TN
3	207Q00000X	Family Medicine Physician	5692	TN

General Provider Information

NPI Number	:	1871174896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO ANTONIO GARCIA DO

Provider Business Mailing Address
First Line	:	965 RIDGE LAKE BLVD STE 315
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9401
Country	:	US
Telephone Number	:	901-227-8693
Fax Number	:	901-226-1351

Provider Business Practice Location Address
First Line	:	6401 POPLAR AVE STE 610
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4806
Country	:	US
Telephone Number	:	901-227-5045
Fax Number	:	901-224-5043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	01/09/2026

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