Clinton Wayne Jackson Jr., LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

CSW004875 Issued in GA

Practice address

6600 Van Aalst Blvd
Fort Moore, GA 31905-2102

Phone

(762) 408-4065

NPI assigned

May 3, 2008

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

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": "1209772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1346416955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MARTIN ARMY COMMUNITY HOSPITAL",
            "address_2": "6600 VAN AALST BOULEVARD",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "31905",
            "telephone_number": "762-408-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "762-408-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CLINTON",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-03",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "CSW004875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy Lou Hudley, HYGIENIST
• Ashley N Hudson, PA-C
• Kevin Patrick Hudson, MD
• Wesley Neal Hudson, CRNA
• Neil E Isom, P.T.
• Xavier Orlando Jacques, MD
• William Timothy Jaegle, D.O.
• Lauren Jensen
• Lee Jin, PA
• Rebecca Johnson, LCSW

• Social Worker in Fort Moore, GA
• Providers in Fort Moore, GA by specialty
• Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.

Verify at the official NPI Registry.