Active NPI
Deallen Jackson
- Behavior Technician
- Covington, GA
National Provider Identifier
1487412920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2131 Stallings St NW # 2832
Covington, GA 30014-2351 - Phone
- (770) 895-2978
- Fax
- (678) 550-9431
- NPI assigned
- Mar 11, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
2131 Stallings St NW # 2832
Covington, GA 30014-2351
Mailing address
2131 Stallings St NW # 2832
Covington, GA 30014-2351
Phone (770) 895-2978
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Performance ABA Therapy LLC | Behavior Technician | Current | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710115200000",
"number": "1487412920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2131 STALLINGS ST NW # 2832",
"city": "COVINGTON",
"state": "GA",
"postal_code": "300142351",
"telephone_number": "770-895-2978",
"fax_number": "678-550-9431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2131 STALLINGS ST NW # 2832",
"city": "COVINGTON",
"state": "GA",
"postal_code": "300142351",
"telephone_number": "770-895-2978",
"fax_number": "678-550-9431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEALLEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-11",
"last_updated": "2024-03-11",
"certification_date": "2024-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covington, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.