Leroy Thomas Jackson, M.D.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

4301406300 Issued in MI

Practice address

3205 Churchland Blvd
Chesapeake, VA 23321-5205

Phone

(757) 484-7822

Fax

(757) 484-7362

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Alabama Medical Group, PC

  • Internal Medicine Physician
  • Mobile, AL
  • NPI 1841712684
  NPD
• Aiyan Diabetes Center Inc

  • Podiatrist
  • Augusta, GA
  • NPI 1568748978
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360886400000",
    "number": "1477633980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 CHURCHLAND BLVD",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215205",
            "telephone_number": "757-484-7822",
            "fax_number": "757-484-7362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 CHURCHLAND BLVD",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215205",
            "telephone_number": "757-484-7822",
            "fax_number": "757-484-7362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LEROY",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2013-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "4301406300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "51109153",
            "identifier": "BLUE CROSS",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1477633980",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashantiana Wilshena, Jemila Jackson
• Brianna Jackson, RPH
• Channon Jackson
• Daniel Solomon Jackson, PA-S
• Krishonda Jackson
• Marcus Joseph Jackson
• Maria Susanne Jackson
• Martina Jackson
• Porcher Jackson
• Vera Roberts Jackson, PHARM.D.

• Endocrinology, Diabetes & Metabolism Physician in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; 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.