MEDICARE: JESSICA SIMONE GARCIA LMT, RYT200

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202D00000X	Integrative Medicine Physician	338363	GA
2	225700000X	Massage Therapist	MT014342	GA

General Provider Information

NPI Number	:	1548966047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SIMONE GARCIA LMT, RYT200

Provider Business Mailing Address
First Line	:	5011 CHARLIE DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-9180
Country	:	US
Telephone Number	:	706-306-3775
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 COLUMBIA RD.
Second Line	:	SUITE 4-A, OFFICE 2
City	:	MARTINEZ
State	:	GA
Zip	:	30907-3090
Country	:	US
Telephone Number	:	706-306-3775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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