Provider Demographics
NPI:1548966047
Name:GARCIA, JESSICA SIMONE (LMT, RYT200)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SIMONE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMT, RYT200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 CHARLIE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9180
Mailing Address - Country:US
Mailing Address - Phone:706-306-3775
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD.
Practice Address - Street 2:SUITE 4-A, OFFICE 2
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-3090
Practice Address - Country:US
Practice Address - Phone:706-306-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA338363202D00000X
GAMT014342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine