Active NPI
Evelyn Jackson, LCSW
- Military Health Care Provider
- Columbus, GA
National Provider Identifier
1275625568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- LCSW
- Practice address
- 209 Miller Loop
Fort Benning
Columbus, GA 31905-6560 - Phone
- (706) 545-1661
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | LCSW | LA | Primary |
Addresses
Primary practice location
209 Miller Loop
Fort Benning
Columbus, GA 31905-6560
Mailing address
209 Miller Loop
Fort Benning
Columbus, GA 31905-6560
Phone (706) 545-1661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW | LA | MD | Military Health Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275625568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 MILLER LOOP",
"address_2": "FORT BENNING",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319056560",
"telephone_number": "706-545-1661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 MILLER LOOP",
"address_2": "FORT BENNING",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319056560",
"telephone_number": "706-545-1661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EVELYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "LA",
"license": "LCSW",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, GA
Sources for this page
- 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.