Active NPI
Brionka Jackson, RBT
- Behavior Technician
- Powder Springs, GA
National Provider Identifier
1386392256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 22-204210
- Practice address
- 4080 Vine Ridge Dr
Powder Springs, GA 30127-1788 - Phone
- (770) 763-8592
- NPI assigned
- Mar 10, 2022
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 22-204210 | GA | Primary |
Addresses
Primary practice location
4080 Vine Ridge Dr
Powder Springs, GA 30127-1788
Mailing address
4080 Vine Ridge Dr
Powder Springs, GA 30127-1788
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22-204210 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646870400000",
"number": "1386392256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4080 VINE RIDGE DR",
"city": "POWDER SPRINGS",
"state": "GA",
"postal_code": "301271788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4080 VINE RIDGE DR",
"city": "POWDER SPRINGS",
"state": "GA",
"postal_code": "301271788",
"telephone_number": "770-763-8592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BRIONKA",
"name_prefix": "Mrs.",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-10",
"last_updated": "2022-03-10",
"certification_date": "2022-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "22-204210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Powder Springs, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.