Active NPI
Henry Jackson
- Internal Medicine Physician
- Augusta, GA
National Provider Identifier
1285643452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 020320
- Practice address
- 1 Freedom Way
Vamc-Augusta-Ud (26)
Augusta, GA 30904-6258 - Phone
- (706) 733-0188
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 020320 | GA | Primary |
Addresses
Primary practice location
1 Freedom Way
Vamc-Augusta-Ud (26)
Augusta, GA 30904-6258
Mailing address
PO Box 3677
Augusta, GA 30914-3677
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 |
|---|---|---|---|
| 020320 | GA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285643452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3677",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309143677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 FREEDOM WAY",
"address_2": "VAMC-AUGUSTA-UD (26)",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309046258",
"telephone_number": "706-733-0188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HENRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "020320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, 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.