Kimberly Jackson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001774 Issued in GA

Practice address

277 Highway 74 N
Ste 203
Peachtree City, GA 30269-1569

Phone

(678) 364-0337

Fax

(678) 364-0858

NPI assigned

May 31, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1053672634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 HIGHWAY 74 N",
            "address_2": "STE 203",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691569",
            "telephone_number": "678-364-0337",
            "fax_number": "678-364-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Insight Assessment Solutions
• Integrated Care Resources of Georgia, LLC
• Integrated Care Resources, Inc
• Noble Chukwuemeka Iwuagwu, MD
• Anne Marie Jackson, PT
• Kadijatu Nadia Jah
• W Steen James, M.D.
• Hyoyoung Jang
• Amy Fowler Jaynes, MS, LPC, NCC, CRC
• Jays Medical Supplies

• Athletic Trainer in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.

Verify at the official NPI Registry.