Active NPI
Edwina Sue Jackson, RN
- Registered Nurse
- Albany, GA
National Provider Identifier
1013345925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN171447
- Practice address
- 1120 W Broad Ave
Suite C 4
Albany, GA 31707-4397 - Phone
- (229) 430-6061
- Fax
- (229) 430-6002
- NPI assigned
- Oct 31, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN171447 | GA | Primary |
Addresses
Primary practice location
1120 W Broad Ave
Suite C 4
Albany, GA 31707-4397
Mailing address
PO Box 1988
Albany, GA 31702-1988
Phone (229) 430-6061
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN171447 | GA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Albany Area Community SVC. Board | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Public Health or Welfare Agency
- Albany, GA
- NPI 1063464212
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383177600000",
"number": "1013345925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1988",
"city": "ALBANY",
"state": "GA",
"postal_code": "317021988",
"telephone_number": "229-430-6061",
"fax_number": "229-430-6002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 W BROAD AVE",
"address_2": "SUITE C 4",
"city": "ALBANY",
"state": "GA",
"postal_code": "317074397",
"telephone_number": "229-430-6061",
"fax_number": "229-430-6002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EDWINA",
"middle_name": "SUE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-31",
"last_updated": "2013-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "RN171447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.