Healthcare Provider Details

I. General information

NPI: 1871456756
Provider Name (Legal Business Name): FENIXX IN FLOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 COLUMBIA RD STE 4A
MARTINEZ GA
30907-0403
US

IV. Provider business mailing address

4210 COLUMBIA RD STE 4A
MARTINEZ GA
30907-0403
US

V. Phone/Fax

Practice location:
  • Phone: 706-666-6984
  • Fax:
Mailing address:
  • Phone: 706-666-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SIMONE GARCIA
Title or Position: CEO
Credential:
Phone: 706-306-3775