Jeremy Jackson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-19-97334

Practice address

2185 Normandie Dr
Montgomery, AL 36111-2728

Phone

(334) 202-4638

NPI assigned

Aug 28, 2019

Last updated

Jul 9, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1295383891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 PLAZA WAY NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601141",
            "telephone_number": "786-912-2066",
            "fax_number": "404-393-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2185 NORMANDIE DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361112728",
            "telephone_number": "334-202-4638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-28",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "AL",
            "license": "19-97334",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-19-97334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RBT",
            "identifier": "RBT-19-97334",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RBT",
            "identifier": "RBT-19-97334",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jeremy@pathwaysbehavior.com",
            "affiliation": "N",
            "address_1": "50 Plaza Way NW Ste A",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeremy@pathwwaysbehavior.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "50 Plaza Way NW Ste A",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Debrica Jackson
• Fredrick J Jackson, OD
• Jacqueline R Jackson
• Janet E. Jackson, M.ED., SLPC
• Janetta Jackson, LMSW
• Joni Virginia Jackson
• Keith Jackson, PHD
• Labrina F Jackson, ATC, LAT
• Latoya Jackson
• Laura Gail Jackson, ALC

• Behavior Technician in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Behavior Technician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.