Active NPI
Jessika Renee Jackson, MD
- Pediatrics Physician
- Smyrna, GA
National Provider Identifier
1144614520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 80311
- Practice address
- 3200 Highlands Pkwy SE Ste 118
Smyrna, GA 30082-5192 - Phone
- (404) 220-7660
- Fax
- (770) 803-9191
- NPI assigned
- Mar 24, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 80311 | GA | Primary |
Addresses
Primary practice location
3200 Highlands Pkwy SE Ste 118
Smyrna, GA 30082-5192
Mailing address
3200 Highlands Pkwy SE Ste 118
Smyrna, GA 30082-5192
Phone (404) 220-7660
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160105001299 | GA | Order and Referring Only - Pediatric Medicine | 7810299096 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80311 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Pediatrics Associates | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679356800000",
"number": "1144614520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 HIGHLANDS PKWY SE STE 118",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300825192",
"telephone_number": "404-220-7660",
"fax_number": "770-803-9191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 HIGHLANDS PKWY SE STE 118",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300825192",
"telephone_number": "404-220-7660",
"fax_number": "770-803-9191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JESSIKA",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-24",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "80311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; 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.