Sophia Evette Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN117221 Issued in GA

Practice address

1950 Buford Hwy
CVS Caremark Minute Clinic
Buford, GA 30518-3673

Phone

(770) 945-7286

NPI assigned

Dec 20, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA, SC, MI, MN4 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 4

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medcare Studios LLC

  • Clinic/Center
  • Buford, GA
  • NPI 1588430789
  Medicare reassignment NPD Authorized official
• Vpa PC

  dba Harmonycares Medical Group

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1164149365
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  GA, MI, MN, SC

  Medicare reassignment NPD
• TLC of Georgia LLC

  dba The Little Clinic

  • Family Nurse Practitioner
  • Jefferson, GA
  • NPI 1750677241
  NPD
• Vpa PC

  dba Harmonycares Medical Group

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1750066932
  NPD
• Vpa PC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD
• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  NPD (past)
• MC Medical LLC

  • General Practice Physician
  • Dallas, GA
  • NPI 1356907695
  NPD (past)

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1093879769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4249 BRENTWOOD DR",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305189008",
            "telephone_number": "770-292-8634",
            "fax_number": "770-965-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 BUFORD HWY",
            "address_2": "CVS CAREMARK MINUTE CLINIC",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305183673",
            "telephone_number": "770-945-7286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SOPHIA",
        "middle_name": "EVETTE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN117221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00792426C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elan Ivy
• Surrea Oglesby Ivy
• Heather Jackson, OTR/L
• Jubrenza Renae Jackson, APC
• Monique Lasean Jackson, MA
• Dustin Christopher Jacobs, DDS
• James E Carter, IV, DMD, PC
• Raquel Renee James, LMSW
• Min Ji Elizabeth Jang, OD
• Glory Jason, RN,N.P

• Family Nurse Practitioner in Buford, GA
• Providers in Buford, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.