Healthcare Provider Details

I. General information

NPI: 1184423923
Provider Name (Legal Business Name): JESSICA J FLOW-BAGWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 AUSTIN DR
DEMOREST GA
30535-4513
US

IV. Provider business mailing address

2579 HIGHWAY 105
DEMOREST GA
30535-2123
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-8811
  • Fax:
Mailing address:
  • Phone: 706-676-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN203155
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: