Active NPI
Vincent Paul Jackson, RT(R)
- Radiologic Technologist
- Atlanta, GA
National Provider Identifier
1033471669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- 394412
- Practice address
- 4950 Glaze Dr
Atlanta, GA 30360-1702 - Phone
- (770) 990-6821
- NPI assigned
- Jun 11, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | 394412 | MN | Primary |
Addresses
Primary practice location
4950 Glaze Dr
Atlanta, GA 30360-1702
Mailing address
4950 Glaze Dr
Atlanta, GA 30360-1702
Phone (770) 990-6821
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 394412 | MN | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339372800000",
"number": "1033471669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4950 GLAZE DR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303601702",
"telephone_number": "770-990-6821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4950 GLAZE DR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303601702",
"telephone_number": "770-990-6821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "VINCENT",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"credential": "RT(R)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-11",
"last_updated": "2012-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "MN",
"license": "394412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.