Jackie L. Williamson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

030925 Issued in GA

Practice address

9766 Hwy 92
Suite 200
Woodstock, GA 30188

Phone

(770) 926-9846

Fax

(770) 693-9859

NPI assigned

Oct 2, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cherokee Family Medical Center, Inc

  • Primary Care Clinic/Center
  • Woodstock, GA
  • NPI 1497897631
  Authorized official Same address or phone
• Piedmont Medical Care Corporation

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1912956046

  Family Medicine

  NPD (past)
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1477646016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9766 HIGHWAY 92 STE 200",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301886456",
            "telephone_number": "770-926-9846",
            "fax_number": "770-693-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9766 HWY 92",
            "address_2": "SUITE 200",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30188",
            "telephone_number": "770-926-9846",
            "fax_number": "770-693-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "JACKIE",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "030925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202I088114",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacara Williams
• Kennedy Williams
• Michael D'Armond Williams, DMD,MS
• Tiffanie Wigstrom Williams, LPC
• Vincent Dean Williams, D.C.
• Megan E Willis, LPN
• Tamatha Dale Willis, C-MMP
• Rugenia Wilson
• Megan Elizabeth Winchester, LMSW
• Emilie Windham, PT

• Family Medicine Physician in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.