Active NPI
Meyonca Jackson, PHARMD,
- Oncology Pharmacist
- Stockbridge, GA
National Provider Identifier
1376146274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oncology Pharmacist
- License
- RPH031536
- Practice address
- 1045 Southcrest Dr
Stockbridge, GA 30281-6113 - Phone
- (678) 289-0549
- NPI assigned
- Nov 21, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Oncology Pharmacist | 1835X0200X | RPH031536 | GA | Primary |
Addresses
Primary practice location
1045 Southcrest Dr
Stockbridge, GA 30281-6113
Mailing address
509 Wyncroft Way
McDonough, GA 30253-8020
Phone (404) 993-4068
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | GA | NA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Stockbridge | Health Information Exchange (HIE) |
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH031536 | GA | MD | Oncology Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Imaging LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Diagnostic Radiology Physician
- Warner Robins, GA
- NPI 1316394976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605916800000",
"number": "1376146274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 WYNCROFT WAY",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302538020",
"telephone_number": "404-993-4068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 SOUTHCREST DR",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302816113",
"telephone_number": "678-289-0549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MEYONCA",
"credential": "PHARMD,",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-21",
"last_updated": "2020-11-21",
"certification_date": "2020-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1835X0200X",
"taxonomy_group": "",
"desc": "Pharmacist, Oncology",
"state": "GA",
"license": "RPH031536",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "NA",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Stockbridge",
"affiliation": "N",
"endpointDescription": "Place of Business",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1045 Southcrest Dr",
"city": "Stockbridge",
"state": "GA",
"country_code": "US",
"postal_code": "302816113",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.