NPIMap

Individual provider Active NPI

Tanjela M Jackson, MD

  • Nephrology Physician
  • Atlanta, GA
National Provider Identifier
1265420574
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
054755 Issued in GA
Practice address
3620 M L King Jr Dr SW
Atlanta, GA 30331-3711
Phone
(404) 696-7300
Fax
(404) 699-3514
NPI assigned
Oct 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 054755 GA Primary

Addresses

Primary practice location

3620 M L King Jr Dr SW
Atlanta, GA 30331-3711

Mailing address

3620 Martin Luther King Jr Dr SW
Atlanta, GA 30331-3711
Phone (404) 696-7300

Other identifiers 12

IdentifierTypeStateIssuer
2490487OtherGAUNITED HEALTH CARE
748360477FMedicaidGA
748360477HMedicaidGA
748360477MedicaidGA
7889745OtherGAAETNA
52152577OtherGABCBS
7368440OtherGACIGNA
748360477GMedicaidGA
748360477KMedicaidGA
748360477EMedicaidGA
748360477IMedicaidGA
748360477JMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tanjela.jackson.1@16547.direct.athenahealth.com

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
I20040818001365 GA Practitioner - NephrologyPractitioner - Internal Medicine 2860465630 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Morehouse School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Atlanta Nephrology, PCGroup PAC ID 2062315088, 9 clinicians

Practice addresses (Care Compare)

3620 Martin Luther King Jr Dr SW
Atlanta, GA 30331-3711
Phone (404) 696-7300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Atlanta Nephrology, PC Nephrology CurrentSince Sep 17, 2007 Accepting new patients

Locations

3620 Martin Luther King Jr Dr SW
Atlanta, GA 30331
Phone (404) 696-7300

1987 Candler Rd
Decatur, GA 30032
Phone (404) 286-1700

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16547/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1265420574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 MARTIN LUTHER KING JR DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303313711",
            "telephone_number": "404-696-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 M L KING JR DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303313711",
            "telephone_number": "404-696-7300",
            "fax_number": "404-699-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TANJELA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "054755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2490487",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7889745",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52152577",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7368440",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477I",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748360477J",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tanjela.jackson.1@16547.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "3620 M L King Jr Dr SW",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303313711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.