Amanda Holloman Jackson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN097491 Issued in GA

Practice address

550 Peachtree St NE Ste 1275
Atlanta, GA 30308-2240

Phone

(404) 872-3121

Fax

(404) 872-3119

NPI assigned

Oct 6, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.jackson@perinatalmed.gadirect.net

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.

• Atlanta Perinatal Associates

  • Maternal & Fetal Medicine Physician
  • Atlanta, GA
  • NPI 1104973064
  NPD
• Pagemed, LLC

  • Maternal & Fetal Medicine Physician
  • Macon, GA
  • NPI 1619274180
  NPD (past)

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1689958837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE STE 1275",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082240",
            "telephone_number": "404-872-3121",
            "fax_number": "404-872-3119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE STE 1275",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082240",
            "telephone_number": "404-872-3121",
            "fax_number": "404-872-3119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "middle_name": "HOLLOMAN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN097491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00311409A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Jackson King, PT
• Gabrielle Jackson-Campbell, LN
• Talondreya Jackson-Noel
• Joi Jackson-Walker, M.D.
• Algernon Hashim Jackson II
• Amy Trobaugh Jackson, PHARMD
• Andrea Jackson, MS, LAPC
• Anee Sophia Jackson, MD
• Angela Denise Jackson, LPC
• Anna Jackson, PAA

• Family Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.