NPIMap

Individual provider Active NPI

Jennifer Jacqueline Jackson, PA

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1235196684
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002415 Issued in GA
Practice address
2001 Peachtree Rd NE Ste 645
Atlanta, GA 30309-1476
Phone
(404) 605-2050
NPI assigned
Apr 28, 2006
Last updated
Jul 31, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 002415 GA
Physician Assistant 363A00000X 002415 GA Primary

Addresses

Primary practice location

2001 Peachtree Rd NE Ste 645
Atlanta, GA 30309-1476

Mailing address

2001 Peachtree Rd NE Ste 645
Atlanta, GA 30309-1476

Other practice location 1

900 Ashwood Pkwy
Suite 850
Atlanta, GA 30338-6999
Phone (404) 531-4197

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080623000392 GA Practitioner - Physician Assistant 7911078712 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Howard University College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Piedmont Providers LLCGroup PAC ID 9830082825, 526 clinicians

Practice addresses (Care Compare)

1984 Peachtree Rd NW
Suite 300
Atlanta, GA 30309-5219
Phone (404) 367-3210

2001 Peachtree Rd NE
Atlanta, GA 30309-1476

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002415GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Grady Memorial Hospital Corporation CurrentSince May 1, 2010 Accepting new patients
Wellstreet of Georgia PC CurrentSince Jul 1, 2016 Accepting new patients
Grady Memorial Hospital Corporation CurrentSince May 1, 2010 Accepting new patients
Angelfish Emergency Physicians, LLC CurrentSince Nov 1, 2009 Accepting new patients
Houston County Emergency Group, LLC CurrentSince Sep 9, 2018 Accepting new patients
Grady Memorial Hospital Corporation CurrentSince Jan 1, 2007 Accepting new patients
Csra Emergency Physicians Past Accepting new patients

Locations

2292 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 382-9941

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1235196684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 PEACHTREE RD NE STE 645",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 PEACHTREE RD NE STE 645",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091476",
            "telephone_number": "404-605-2050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Ashwood Pkwy",
            "address_2": "Suite 850",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303386999",
            "country_code": "US",
            "telephone_number": "404-531-4197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "GA",
            "license": "002415",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.