Active NPI
Jerett Stockham
- Family Nurse Practitioner
- Atlanta, GA
National Provider Identifier
1326639261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN263866
- Practice address
- 1001 Johnson Ferry Rd
Atlanta, GA 30342-1605 - Phone
- (404) 785-4258
- NPI assigned
- Feb 2, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN263866 | GA | Primary |
Addresses
Primary practice location
1001 Johnson Ferry Rd
Atlanta, GA 30342-1605
Mailing address
1001 Buckeye LN
Villa Rica, GA 30180-5328
Phone (678) 850-0985
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1326639261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 BUCKEYE LN",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301805328",
"telephone_number": "678-850-0985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 JOHNSON FERRY RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421605",
"telephone_number": "404-785-4258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOCKHAM",
"first_name": "JERETT",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-02",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN263866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.