Phillip Gaynor Jackson, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

048248 Issued in GA

Practice address

5500 Rockton Wood Way SW
Atlanta, GA 30331-8904

Phone

(404) 494-9540

Fax

(404) 344-3706

NPI assigned

Feb 19, 2007

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)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

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.

• Georgia Department of Human Resources

  • Psychiatric Hospital
  • Columbus, GA
  • NPI 1144224767
  NPD (past)
• Orohealth Corporation a Non Profit Healthcare System

  • Family Medicine Physician
  • Oroville, CA
  • NPI 1013933167

  Internal Medicine

  NPD (past)
• Oroville Hospital

  • General Acute Care Hospital
  • Oroville, CA
  • NPI 1710372909
  NPD (past)

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265576581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 ROCKTON WOOD WAY SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303318904",
            "telephone_number": "404-494-9540",
            "fax_number": "404-344-3706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 ROCKTON WOOD WAY SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303318904",
            "telephone_number": "404-494-9540",
            "fax_number": "404-344-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHILLIP",
        "middle_name": "GAYNOR",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "048248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• My Lien Thi Jackson
• Nathan Isaac Jackson
• Nichelle Jackson, MSN, NP-BC
• Nicole Denise Jackson, DSW, LMSW
• Nicolette Jackson
• Ramsey Elliott Jackson, M.D.
• Reginald Roberts Jackson, M.D.
• Roger Lee Jackson II
• Ryan Theron Jackson
• Samuel Lee Jackson

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.