Robert Boyd Jackson IV, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8512 Issued in TN

Practice address

2400 White Ave
Nashville, TN 37204-2235

Phone

(615) 460-4171

NPI assigned

Feb 19, 2008

Last updated

Apr 10, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1710155197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 BROKESHIRE DR",
            "city": "WHITE HOUSE",
            "state": "TN",
            "postal_code": "371881593",
            "telephone_number": "615-982-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 WHITE AVE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372042235",
            "telephone_number": "615-460-4171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2275 Brokeshire Dr",
            "address_purpose": "LOCATION",
            "city": "White House",
            "state": "TN",
            "postal_code": "371881593",
            "country_code": "US",
            "telephone_number": "615-982-5859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERT",
        "middle_name": "BOYD",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-19",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "8512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martisia Jackson, PHARM D
• Mary Elizabeth Jackson, P.T.
• Noelle Morgan Jackson
• Peyton Spies Jackson, APRN
• Renee Camille Jackson, BCBA
• Samuel S Jackson III, D.D.S.
• Sandra Jackson, APRN
• Sharon Ann Jackson, MD
• Starr Unique Jackson, AU.D.
• Stephanie Dragoo Jackson, COTA/L

• Clinical Social Worker in Nashville, TN
• Providers in Nashville, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.