Provider Demographics
NPI:1871174896
Name:GARCIA, MARIO ANTONIO (DO)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ANTONIO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:901-227-8693
Mailing Address - Fax:901-226-1351
Practice Address - Street 1:6401 POPLAR AVE STE 610
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4806
Practice Address - Country:US
Practice Address - Phone:901-227-5045
Practice Address - Fax:901-224-5043
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-05-01
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Provider Licenses
StateLicense IDTaxonomies
MST-4850207Q00000X
TNPENDING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine