Billie L. Jackson, M.D., LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

030791 Issued in GA

Legal business name

BILLIE L. JACKSON, M.D., LLC

Practice address

440 Charter Blvd
Suite 2201
Macon, GA 31210-0724

Phone

(478) 477-5575

Fax

(478) 477-0707

NPI assigned

Dec 15, 2011

Organization subpart

No

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

Authorized official

Name

Billie L Jackson, M.D.NPI 1235232430

Title

Owner

Phone

(478) 477-5575

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Billie Luke Jackson, M.D.

  • Dermatology Physician
  • Macon, GA
  • NPI 1235232430
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1114296464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 CHARTER BLVD",
            "address_2": "SUITE 2201",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312100724",
            "telephone_number": "478-477-5575",
            "fax_number": "478-477-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 CHARTER BLVD",
            "address_2": "SUITE 2201",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312100724",
            "telephone_number": "478-477-5575",
            "fax_number": "478-477-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BILLIE L. JACKSON, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-477-5575",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "030791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000373513E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Aina Bibbs
• Evelyn Ogburn Bickley, M.D.
• Justin Alexander Billings, M.D.
• William F Bina, MD
• Tomica Denise Binns, NP
• Bio-Medical Applications of Georgia Inc
• Bio-Medical Applications of Georgia Inc

• Dermatology Physician in Macon, GA
• Providers in Macon, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.