Provider Demographics
NPI:1528076759
Name:GARCIA, ANGEL RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:RAFAEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:428 POPLAR ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7975
Mailing Address - Country:US
Mailing Address - Phone:478-745-7773
Mailing Address - Fax:478-745-7676
Practice Address - Street 1:428 POPLAR ST
Practice Address - Street 2:SUITE C
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7975
Practice Address - Country:US
Practice Address - Phone:478-745-7773
Practice Address - Fax:478-745-7676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAGA011802207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD08250Medicare UPIN