Provider Demographics
NPI:1104280668
Name:GARCIA, KRYSTAL V (DO)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:V
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KRYSTAL
Other - Middle Name:VICTORIA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:215 COLUMNS WAY APT 115
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-1399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1607 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4011
Practice Address - Country:US
Practice Address - Phone:912-539-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4220207P00000X
GA82398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty