Tackett Medical, PLLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

TACKETT MEDICAL, PLLC

Practice address

5640 Marblehead Dr
Colfax, NC 27235-9801

Phone

(501) 676-1410

NPI assigned

Jan 17, 2025

Last updated

Jan 17, 2025By 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

Jonathan Kenton Tackett, MDNPI 1407203888

Title

Ceo

Phone

(501) 676-1410

Specialties & licenses 1

Addresses

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.

• Jonathan Kenton Tackett, M.D.

  • Family Medicine Physician
  • Chapel Hill, NC
  • NPI 1407203888

  Geriatric Medicine

  NPD Authorized official

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

{
    "created_epoch": "1737072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1245041243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 MARBLEHEAD DR",
            "city": "COLFAX",
            "state": "NC",
            "postal_code": "272359801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 MARBLEHEAD DR",
            "city": "COLFAX",
            "state": "NC",
            "postal_code": "272359801",
            "telephone_number": "501-676-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACKETT MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-17",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "TACKETT",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "KENTON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-676-1410",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessenia A Salazar
• Luis Alberto Sanchez, PTA
• Heather R. Smith, PT
• Hannah Spach, OT
• Tasnim Sultana, MBBS, MPH
• Timothy Barber, DMD, P.a.
• Gina M Tucker
• Jessica D Whitehead, MA CCC-SLP

• Geriatric Medicine (Family Medicine) Physician in Colfax, NC
• Providers in Colfax, NC by specialty
• Geriatric Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.