William Thomas Jackson, M.S., ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1364 Clifton Rd NE
Atlanta, GA 30322-1059

Phone

(404) 727-7825

NPI assigned

Oct 9, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

95.67 of 100Reported as group

Improvement activities

40

Cost

79.56

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baldwin Emergency Group, LLC

  • Emergency Medicine Physician
  • Milledgeville, GA
  • NPI 1306206826
  Medicare reassignment
• Peach State Emergency Physicians LLC

  • Emergency Medicine Physician
  • Augusta, GA
  • NPI 1053170605
  Medicare reassignment
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1013311752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 362",
            "city": "HAMILTON",
            "state": "GA",
            "postal_code": "318110362",
            "telephone_number": "706-325-8482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221059",
            "telephone_number": "404-727-7825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1081 Rocky Branch Road",
            "address_purpose": "LOCATION",
            "city": "Bogart",
            "state": "GA",
            "postal_code": "30622",
            "country_code": "US",
            "telephone_number": "706-769-7760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WILLIAM",
        "middle_name": "THOMAS",
        "credential": "M.S., ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-09",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT002062",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Venita Joy Jackson, P.A.-C
• Victoria Jackson
• Vincent Paul Jackson, RT(R)
• Wendy S Jackson, FNP-C
• Whitney Jackson
• Wykena Jatawn Jackson, M.D.
• Yolanda Trenett Jackson, PTA
• Zipphrah F Jackson, COTA/L
• Christine Mary Jacob, APRN
• Jesse Thomas Jacob, MD

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.