Shatara Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW008276 Issued in GA

Practice address

5 Mall Anx
Savannah, GA 31406-4738

Phone

(912) 495-8887

Fax

(912) 495-8881

NPI assigned

Oct 17, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• J.C. Lewis Primary Healthcare Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1922301472

  Single Specialty

  Medicare reassignment NPD
• J C Lewis Primary Health Care Center

  • Pharmacy
  • Savannah, GA
  • NPI 1508453994
  NPD

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1033660949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S PARKWOOD DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314045213",
            "telephone_number": "912-507-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MALL ANX",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064738",
            "telephone_number": "912-495-8887",
            "fax_number": "912-495-8881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6711 Forest Park Dr",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314062507",
            "country_code": "US",
            "telephone_number": "912-429-8452",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50 S Parkwood Dr",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314045213",
            "country_code": "US",
            "telephone_number": "912-507-0326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHATARA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-17",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "15612",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW008276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026265E",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcella Jackson, CNA/MAA
• Michael Joseph Jackson, MD
• Nicole S Jackson, FNP
• Nkenge Ayeola Jackson, M.D.
• Paige B Jackson, AA
• Teliyah Nevaeh Jackson
• Trinity Jackson
• Errol Jacobi, M.D.
• Ashley Nicole Jacobs, M.S.
• Glenda R. Jacobs, RN, CDE

• Clinical Social Worker in Savannah, GA
• Providers in Savannah, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.