William Henry Jackson Jr., M.D., M.B.A

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

38696 Issued in SC

Practice address

701 Grove Rd FL 1
Greenville, SC 29605-4210

Phone

(864) 455-7899

Fax

(864) 455-5474

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL, SC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
• Direct secure messaging: wjackson248724@direct.ghs.myhfn.org

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.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment NPD
• Emergency Services of Montgomery PC

  • Emergency Medicine Physician
  • Prattville, AL
  • NPI 1528310323
  Medicare reassignment NPD
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459
  Medicare reassignment NPD
• Prisma Health University Medical Group

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Brightpoint Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Stockbridge, GA
  • NPI 1508915919
  NPD
• Coweta Emergency Group LLC

  • Emergency Medicine Physician
  • Newnan, GA
  • NPI 1245556588
  NPD
• Cascade Emergency Services

  • Emergency Medicine Physician
  • Atlanta, GA
  • NPI 1003967225
  NPD (past)
• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  NPD (past)
• Lagrange Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Lagrange, GA
  • NPI 1760437560
  NPD (past)
• Peachtree Emergency Associates

  • Emergency Medicine Physician
  • Atlanta, GA
  • NPI 1407894876
  NPD (past)
• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  NPD (past)

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1528032208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD FL 1",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-7899",
            "fax_number": "864-455-5474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "913 Eagles Landing Pkwy",
            "address_2": "Suite 150",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302815011",
            "country_code": "US",
            "telephone_number": "770-692-5910",
            "fax_number": "770-692-5916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "913 Eagles Landing Pkwy",
            "address_2": "Suite 150",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302815011",
            "country_code": "US",
            "telephone_number": "770-692-5910",
            "fax_number": "770-692-5916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WILLIAM",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D., M.B.A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "35913",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "38696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wjackson248724@direct.ghs.myhfn.org",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "wjackson248724@direct.ghs.myhfn.org",
            "address_1": "701 Grove Rd Fl 1",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296054210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nina Katherine Trent Jackson, PA-C
• Samuel Collins Jackson, DPT
• Tiffany Michelle Jackson, LPN
• Timothy G Jackson, MMFT, LMFT-A
• Tyla Jackson
• William Morgan Jackson, DPT
• George Mack Jacob, M.D.
• Bernadette Ann Jacobs, OT
• Jeannine M Jacobs, CPNP
• Ronnie Jacobs Jr.

• Emergency Medicine Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.