Michelle A Jackson, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY004033 Issued in GA

Practice address

2020 Peachtree Rd NW
Atlanta, GA 30309-1426

Phone

(404) 367-1310

NPI assigned

Jul 22, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shepherd Center, Inc.Group PAC ID 1052301777, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Shepherd Center Inc

  • Long Term Care Hospital
  • Atlanta, GA
  • NPI 1043311715
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517356800000",
    "number": "1346553021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 PEACHTREE RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091426",
            "telephone_number": "404-350-7323",
            "fax_number": "404-350-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 PEACHTREE RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091426",
            "telephone_number": "404-367-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-22",
        "last_updated": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": "PSY004033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026265E",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "685661",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Jackson
• Malaina Jackson
• Mariah Jackson
• Michael A Jackson, PHARM D
• Michele Natesha Jackson, RN, BSN
• Monica Denice Jackson, HAIR RESTORATION S
• Montina Golphin Jackson, DMD
• My Lien Thi Jackson
• Nathan Isaac Jackson
• Nichelle Jackson, MSN, NP-BC

• Clinical Neuropsychologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Clinical Neuropsychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.