Brian Jackson, DR. AD, CAP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

4410 Issued in FL

Practice address

3 Shircliff Way Ste 640
Jacksonville, FL 32204-4787

Phone

(904) 389-3784

NPI assigned

Nov 22, 2016

Sex

Male

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)

Not enrolled

State licenses

Practice roles

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.

• Greenfield Center Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Jacksonville, FL
  • NPI 1952484438
  NPD (past)

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1215470380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SHIRCLIFF WAY STE 640",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044787",
            "telephone_number": "904-389-3784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SHIRCLIFF WAY STE 640",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044787",
            "telephone_number": "904-389-3784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "DR. AD, CAP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-22",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "4410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antoinique Jackson
• Arnitra N Jackson
• Arshea Jackson
• Ashley Jackson
• Beverly Jackson, ARNP
• Caleb K Jackson
• Chaunyale Tiffany Jackson, RN
• Cheryl Jackson, PA
• Christina Olivia Jackson
• Cindy Lee Jackson, OTR/L

• Addiction (Substance Use Disorder) Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Addiction (Substance Use Disorder) Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; 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.