Active NPI
Thomas M Jackson, DMD, MSD
- Periodontics
- Jonesboro, AR
National Provider Identifier
1619403615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 39
- Practice address
- 2737 Paula Dr
Jonesboro, AR 72404-8017 - Phone
- (901) 932-0015
- NPI assigned
- May 11, 2017
- Last updated
- Jul 27, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 39 | AR | Primary |
Addresses
Primary practice location
2737 Paula Dr
Jonesboro, AR 72404-8017
Mailing address
PO Box 327
Walnut Ridge, AR 72476-0327
Phone (870) 886-7992
Other practice location 1
12018 Chenal Pkwy
Little Rock, AR 72211-2759
Phone (501) 225-1577
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39 | AR | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595808000000",
"number": "1619403615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 327",
"city": "WALNUT RIDGE",
"state": "AR",
"postal_code": "724760327",
"telephone_number": "870-886-7992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2737 PAULA DR",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724048017",
"telephone_number": "901-932-0015"
}
],
"practiceLocations": [
{
"address_1": "12018 Chenal Pkwy",
"address_purpose": "LOCATION",
"city": "Little Rock",
"state": "AR",
"postal_code": "722112759",
"country_code": "US",
"telephone_number": "501-225-1577",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "THOMAS",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DMD, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-11",
"last_updated": "2020-07-27",
"certification_date": "2020-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AR",
"license": "39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.