Provider Demographics
NPI:1083650972
Name:RENDON-GARCIA, JOSE M (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:RENDON-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 1:11909D MCAULEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1709
Mailing Address - Country:US
Mailing Address - Phone:912-927-0785
Mailing Address - Fax:912-927-6572
Practice Address - Street 1:11909D MCAULEY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1709
Practice Address - Country:US
Practice Address - Phone:912-927-0785
Practice Address - Fax:912-927-6572
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000624709EMedicaid
GAG01554Medicare UPIN
GA11BDRQWMedicare ID - Type Unspecified