Individual provider Active NPI

Jewell Jackson

  • Nursing Care Agency
  • McDonough, GA
National Provider Identifier
1164312849
Registry record updated Jul 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
License
PHCP043323 Issued in GA
Practice address
1078 Climbing Rose Way
McDonough, GA 30253-1941
Phone
(678) 462-6045
NPI assigned
Jul 5, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X PHCP043323 GA Primary

Addresses

Primary practice location

1078 Climbing Rose Way
McDonough, GA 30253-1941

Mailing address

1078 Climbing Rose Way
McDonough, GA 30253-1941
Phone (678) 462-6045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PHCP043323GAMDNursing Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
True Vine Integrative Care, LLC CurrentSince Jul 28, 2025 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": "1751673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751673600000",
    "number": "1164312849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1078 CLIMBING ROSE WAY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302531941",
            "telephone_number": "678-462-6045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1078 CLIMBING ROSE WAY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302531941",
            "telephone_number": "678-462-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JEWELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-05",
        "last_updated": "2025-07-05",
        "certification_date": "2025-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "GA",
            "license": "PHCP043323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2025; 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.