Laverne Jackson

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

RN130090 Issued in GA

Practice address

903 N Court St
Quitman, GA 31643-1315

Phone

(229) 263-7147

Fax

(229) 263-6318

NPI assigned

Nov 27, 2015

Last updated

Nov 27, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Enrolled

State licenses

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

{
    "created_epoch": "1448582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448582400000",
    "number": "1134593353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 N COURT ST",
            "city": "QUITMAN",
            "state": "GA",
            "postal_code": "316431315",
            "telephone_number": "229-263-7147",
            "fax_number": "229-263-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 N COURT ST",
            "city": "QUITMAN",
            "state": "GA",
            "postal_code": "316431315",
            "telephone_number": "229-263-7147",
            "fax_number": "229-263-6318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAVERNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-27",
        "last_updated": "2015-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "RN130090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael William Harrell, PTA
• Jennifer H Hightower, PHYSICAL THERAPIST
• Ryan Hudson, PT, DPT
• Ramsey B Hughes, FNP
• J.H. Harvey Co., LLC (Harveys Supermarket Pharmacy #2408)
• Melissa Jenkins
• Robert Eugene Jennings Jr., PHARM,D
• Robyn E Jimenez, PAC
• John D. Archbold Memorial Hospital (Archbold - Brooks Specialty Clinic)
• John D. Archbold Memorial Hospital, Inc. (Brooks County Dialysis Facility)

• Primary Care Clinic/Center in Quitman, GA
• Providers in Quitman, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2015; 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.