Kristy Hendricks Jackson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

060643 Issued in GA

Practice address

2540 Windy Hill Rd SE
Marietta, GA 30067-8605

Phone

(770) 644-1570

NPI assigned

Apr 15, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ms_kjack346@landmarkhealth-direct.org
• Direct secure messaging: kristyjackson@tdh.allscriptsdirect.net

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.

• Kristy H Jackson MD PC

  • Psychiatry Physician
  • Atlanta, GA
  • NPI 1184031320
  NPD Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Psychiatry

  NPD
• Fulton County Mental Health Center

  • Community/Behavioral Health Agency
  • Atlanta, GA
  • NPI 1437299625
  NPD (past)
• Fulton County Mhddad

  • Community/Behavioral Health Agency
  • Atlanta, GA
  • NPI 1285700682
  NPD (past)

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1043484645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 FAIRBURN RD SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303311907",
            "telephone_number": "404-691-9627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 WINDY HILL RD SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678605",
            "telephone_number": "770-644-1570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Fairburn Rd SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303311907",
            "country_code": "US",
            "telephone_number": "404-691-9627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTY",
        "middle_name": "HENDRICKS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "060643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjackson313163@directwellstar.org",
            "affiliation": "N",
            "address_1": "2540 Windy Hill Rd SE",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300678605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bethany Jackson
• Brandon Travon Jackson, DPT
• Jabria Jackson, SLP
• Jayce Jackson, RBT
• Kierra Jackson
• Rebecca Jackson, FNP
• Robert Wallace Jackson Jr.
• Sheree Jackson, LPC
• Thiha Cadet Jackson, PA-A
• Toni Ann Jackson, OTR/L

• Psychiatry Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; 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.