Active NPI
Rebecca Suzanne Jackson, CNM
- Advanced Practice Midwife
- Gainesville, GA
National Provider Identifier
1679516173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- APRN-CNM136000
- Practice address
- 725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834 - Phone
- (770) 297-2200
- Fax
- (770) 534-8139
- NPI assigned
- Jun 13, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | APRN-CNM136000 | GA | Primary |
Addresses
Primary practice location
725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834
Mailing address
PO Box 658
Gainesville, GA 30503-0658
Phone (770) 718-1122
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1004732 | Other | GA | AMERIGROUP |
| 340852 | Other | GA | WELLCARE |
| 382185596A | Medicaid | GA | |
| 382185596E | Medicaid | GA | |
| 382185596G | Medicaid | GA | |
| 382185596D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Nurse Midwife (CNM)
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834
Phone (770) 297-5700
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN-CNM136000 | GA | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Longstreet Clinic, PC | Current | Accepting new patients | |
| Northeast Georgia Community Physicians LLC | Current | Accepting new patients | |
| The Longstreet Clinic PC | Current | Accepting new patients |
Locations
725 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone (770) 297-2200
Interoperability endpoints
- suzanne.jackson@longstreetclinic.gadirect.net
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Gainesville, GA
- NPI 1881583730
-
- Internal Medicine Physician
- Gainesville, GA
- NPI 1326019977
-
- Prosthetic/Orthotic Supplier
- Gainesville, GA
- NPI 1053422428
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761782400000",
"number": "1679516173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 658",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305030658",
"telephone_number": "770-718-1122",
"fax_number": "770-534-8998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 JESSE JEWELL PKWY SE",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013834",
"telephone_number": "770-297-2200",
"fax_number": "770-534-8139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "REBECCA",
"middle_name": "SUZANNE",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-13",
"last_updated": "2025-10-30",
"certification_date": "2025-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "GA",
"license": "APRN-CNM136000",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "1004732",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "340852",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "382185596A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "382185596E",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "382185596G",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "382185596D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.