Jeneicia Jackson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN101803 Issued in GA

Practice address

270 Heritage Walk
Woodstock, GA 30188-3875

Phone

(678) 494-5700

NPI assigned

Apr 24, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Woodstock Treatment Center LLC

  • Methadone Clinic
  • Woodstock, GA
  • NPI 1508405150
  NPD
• Georgia CTC, LLC

  • Methadone Clinic
  • Dallas, GA
  • NPI 1407582042
  NPD (past)

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1427804269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 GRIER ST APT 203",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301893495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 HERITAGE WALK",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883875",
            "telephone_number": "678-494-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENEICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "LPN101803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly A Izzo, P.T.
• J. Jeff Kincaid, DMD, Ms
• J.a.H. Enterprises, LLC
• Sarah Franze Jabbour, PH.D.
• Alisa McCall Jackson, FNP-C
• Lakeisha Jackson
• Logan Jackson
• Jacob Ward MD, LLC
• Jamie L Jacobs, LMHP, CPC, LPC, LADC
• Jafar Tabatabai M.D. P.C.

• Licensed Practical Nurse in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.