Joseph L Jackson Sr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

013980 Issued in GA

Practice address

305 Jones Ave
Waynesboro, GA 30830-1510

Phone

(706) 554-5147

Fax

(706) 554-6111

NPI assigned

Jun 9, 2006

Sex

Male

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 4

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Medical Specialists

  • Rural Health Clinic/Center
  • Waynesboro, GA
  • NPI 1063459899

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer

  CMS ownership

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.

• Medical Specialists

  • Rural Health Clinic/Center
  • Waynesboro, GA
  • NPI 1063459899

  Family Medicine

  NPD
• Medical Specialists, Inc

  • Rural Health Clinic/Center
  • Wrens, GA
  • NPI 1851334015

  Family Medicine

  NPD

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439251200000",
    "number": "1366483356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 JONES AVE",
            "city": "WAYNESBORO",
            "state": "GA",
            "postal_code": "308301510",
            "telephone_number": "706-554-5147",
            "fax_number": "706-554-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 JONES AVE",
            "city": "WAYNESBORO",
            "state": "GA",
            "postal_code": "308301510",
            "telephone_number": "706-554-5147",
            "fax_number": "706-554-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2015-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "013980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD",
            "identifier": "080028937",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000172213A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD",
            "identifier": "080083685",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000172213C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Akin Hood, MPT
• Hudd Acres LLC
• Amber Marie Huddleston, LPC
• Tamara Alisha Ivy
• J Mark Gresham MD PC
• Jurea Juanita Jackson, LPN
• Amy Johnson Jacobs, PHARM D
• Bonnie P Jenkins, M.D.
• Sarah Jenkins
• Monnessia Latreal Johnson

• Family Medicine Physician in Waynesboro, GA
• Providers in Waynesboro, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.