Provider Demographics
NPI:1043533243
Name:GARCIA, MADELYN (PA-C)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:GARCIA
Other - Last Name:SERINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2605 KINARD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2967
Mailing Address - Country:US
Mailing Address - Phone:803-405-1900
Mailing Address - Fax:803-405-1919
Practice Address - Street 1:2605 KINARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2967
Practice Address - Country:US
Practice Address - Phone:803-405-1900
Practice Address - Fax:803-405-1919
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1150OtherPA-C SOUTH CAROLINA LICENSE