Michael S. Jackson, MD, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

055376 Issued in GA

Legal business name

MICHAEL S. JACKSON, MD, PC

Doing business as

Your Personal Physician

Practice address

701 E 2ND Ave SW
Suite C
Rome, GA 30161-6148

Phone

(706) 266-9090

Fax

(706) 204-8797

NPI assigned

Mar 10, 2010

Last updated

Jan 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael S Jackson, MDNPI 1306830062

Title

President

Phone

(706) 266-9090

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Your Personal Physician Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael S Jackson, MD

  • Family Medicine Physician
  • Rome, GA
  • NPI 1306830062
  Authorized official Same address or phone

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1164745782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "SILVER CREEK",
            "state": "GA",
            "postal_code": "301730040",
            "telephone_number": "706-266-9090",
            "fax_number": "706-204-8797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E 2ND AVE SW",
            "address_2": "SUITE C",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616148",
            "telephone_number": "706-266-9090",
            "fax_number": "706-204-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL S. JACKSON, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-10",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-266-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "055376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL NPI",
            "identifier": "1306830062",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "08BBRKT",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Your Personal Physician",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Margaret Elanie Meyers
• Maria Virginia Meyers, PA-C
• Rita Saveria Mezzatesta, MD
• MH Dental P.C. (Vital Smiles Georgia)
• Jack Anthony Miceli, NP-C
• Dawne R Michael, MSN, AGPCNP-C
• Mitzie Marion Colet Mickelson, OTR/L, CPAM
• Brian Middleton, DPM
• Matthew David Middleton, PHARMD
• Mighty Oaks Pain and Spine Clinic LLC

• Family Medicine Physician in Rome, GA
• Providers in Rome, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; 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.