Healthcare Provider Details

I. General information

NPI: 1548966047
Provider Name (Legal Business Name): JESSICA SIMONE GARCIA LMT, RYT200
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 COLUMBIA RD. SUITE 4-A, OFFICE 2
MARTINEZ GA
30907-3090
US

IV. Provider business mailing address

5011 CHARLIE DR
AUGUSTA GA
30909-9180
US

V. Phone/Fax

Practice location:
  • Phone: 706-306-3775
  • Fax:
Mailing address:
  • Phone: 706-306-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT014342
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number338363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: