Provider Demographics
NPI:1306896865
Name:GARCIA, GODOFREDO I (MD)
Entity type:Individual
Prefix:
First Name:GODOFREDO
Middle Name:I
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:980-212-6018
Mailing Address - Fax:980-487-3294
Practice Address - Street 1:433 MCALISTER RD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4147
Practice Address - Country:US
Practice Address - Phone:980-212-6018
Practice Address - Fax:980-487-3294
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306896865Medicaid
SCNC1349Medicaid
NC5916638Medicaid
SCNC1349Medicaid
NCNCD071FMedicare PIN
NCNCD071DMedicare PIN
NC1306896865Medicaid
NCNCD071GMedicare PIN
NCNCD071EMedicare PIN