Basic Information
| Provider Information | |||||||||
| NPI: | 1700961257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 STONEBRIDGE PKWY | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301893767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784942500 | ||||||||
| FaxNumber: | 6784942629 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 STONEBRIDGE PKWY | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301893767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784942500 | ||||||||
| FaxNumber: | 6784942629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 055587 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 055587 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.