Provider Demographics
NPI:1871364133
Name:GARCIA, JAVIER MALIK
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:MALIK
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 BLOWING WIND CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8907
Mailing Address - Country:US
Mailing Address - Phone:404-663-0139
Mailing Address - Fax:
Practice Address - Street 1:2662 BLOWING WIND CIR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8907
Practice Address - Country:US
Practice Address - Phone:404-663-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician