Active NPI
Kira Jackson
- Prosthetic/Orthotic Supplier
- Atlanta, GA
National Provider Identifier
1407533532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Practice address
- 1055 Howell Mill Rd
Ste 8082 PMB 1050
Atlanta, GA 30318 - Phone
- (478) 336-6169
- NPI assigned
- Jun 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | GA | Primary |
Addresses
Primary practice location
1055 Howell Mill Rd
Ste 8082 PMB 1050
Atlanta, GA 30318
Mailing address
1055 Howell Mill Rd
Ste 8082 PMB 1050
Atlanta, GA 30318
Phone (478) 336-6169
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688083200000",
"number": "1407533532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 HOWELL MILL RD",
"address_2": "STE 8082 PMB 1050",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30318",
"telephone_number": "478-336-6169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 HOWELL MILL RD",
"address_2": "STE 8082 PMB 1050",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30318",
"telephone_number": "478-336-6169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-30",
"last_updated": "2023-06-30",
"certification_date": "2023-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.