Active NPI
Jeffrey Jackson, LGSW
- Social Worker
- Myrtle Beach, SC
National Provider Identifier
1548753965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 3475G
- Practice address
- 2024 Corporate Centre Dr Ste 103
Myrtle Beach, SC 29577-7410 - Phone
- (843) 232-2441
- NPI assigned
- Jun 11, 2018
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 3475G | AL | Primary |
Addresses
Primary practice location
2024 Corporate Centre Dr Ste 103
Myrtle Beach, SC 29577-7410
Mailing address
2024 Corporate Centre Dr Ste 103
Myrtle Beach, SC 29577-7410
Phone (843) 232-2441
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3475G | AL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528675200000",
"number": "1548753965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2024 CORPORATE CENTRE DR STE 103",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295777410",
"telephone_number": "843-232-2441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2024 CORPORATE CENTRE DR STE 103",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295777410",
"telephone_number": "843-232-2441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JEFFREY",
"credential": "LGSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-11",
"last_updated": "2018-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AL",
"license": "3475G",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.