NPIMap

Individual provider Active NPI

Jackson E Hatfield

  • Family Medicine Physician
  • Thomasville, GA
National Provider Identifier
1316238744
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
076616 Issued in GA
Practice address
2621 E Pinetree Blvd
Thomasville, GA 31792-4840
Phone
(229) 584-4100
NPI assigned
Apr 19, 2011
Last updated
Aug 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 076616 GA Primary
Family Medicine Physician 207Q00000X MD.205947 LA

Addresses

Primary practice location

2621 E Pinetree Blvd
Thomasville, GA 31792-4840

Mailing address

900 Cairo Rd
Thomasville, GA 31792-4255

Other identifiers 2

IdentifierTypeStateIssuer
2150405MedicaidLA
04929309MedicaidMS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jackson.hatfield.p16@direct.archbold.nextgenshare.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
I20160825002560 GA Practitioner - Family Practice 8325264013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Archbold Medical Group, Inc.Group PAC ID 8123196383, 80 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

100 Mimosa Dr
Thomasville, GA 31792-6676
Phone (229) 228-5500

2600 Compass Rd
Glenview, IL 60026-8001

2621 E Pinetree Blvd
Thomasville, GA 31792-4840
Phone (229) 584-4100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Archbold Medical Group, Inc. Family Medicine CurrentSince Aug 4, 2016 Accepting new patients
Archbold Medical Group, Inc. CurrentSince Aug 4, 2016 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

100 Mimosa Dr
Thomasville, GA 31792
Phone (229) 226-9141

2621 E Pinetree Blvd
Thomasville, GA 31792
Phone (229) 226-5788

900 Cairo Rd
Thomasville, GA 31792
Phone (229) 227-5102

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1316238744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CAIRO RD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 E PINETREE BLVD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924840",
            "telephone_number": "229-584-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATFIELD",
        "first_name": "JACKSON",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-19",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "076616",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.205947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2150405",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04929309",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackson.hatfield.p16@direct.archbold.nextgenshare.com",
            "affiliation": "N",
            "address_1": "2621 E Pinetree Blvd",
            "city": "Thomasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317924840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.