R. Elliott Jackson Geriatrics,LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

047774 Issued in GA

Legal business name

R. ELLIOTT JACKSON GERIATRICS,LLC

Practice address

2650 Weigelia Rd NE
Atlanta, GA 30345-3969

Phone

(404) 213-3672

Fax

(770) 458-1596

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ramsey Elliott Jackson, M.D.NPI 1275645459

Title

Owner

Phone

(404) 213-3672

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ramsey Elliott Jackson, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Atlanta, GA
  • NPI 1275645459
  Medicare reassignment NPD Authorized official
• Amanda Z. Jackson, O.T.

  • Occupational Therapist
  • Decatur, GA
  • NPI 1457429011
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437261617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3904 N DRUID HILLS RD",
            "address_2": "#222",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300333105",
            "telephone_number": "770-458-1594",
            "fax_number": "770-458-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 WEIGELIA RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453969",
            "telephone_number": "404-213-3672",
            "fax_number": "770-458-1596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. ELLIOTT JACKSON GERIATRICS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RAMSEY",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-213-3672",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "GA",
            "license": "047774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Geriatric Medicine (Internal Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.