Angela Jackson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-22-216258

Practice address

72 Drayton CT
Midway, GA 31320-7142

Phone

(404) 697-3608

Fax

(904) 203-1226

NPI assigned

Jan 5, 2021

Last updated

May 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Puzzling Patterns

  dba Puzzling Patterns Behavior Therapy and Consultation Services

  • Behavior Analyst
  • Midway, GA
  • NPI 1316613250
  NPD

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653177600000",
    "number": "1710575725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 DRAYTON CT",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313207142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 DRAYTON CT",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313207142",
            "telephone_number": "404-697-3608",
            "fax_number": "904-203-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2022-05-22",
        "certification_date": "2022-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-22-216258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antionette N Hayward, CPT
• Amanda Waters Holliday, M.ED, CCC-SLP
• Hospital Authority of Liberty County (Liberty Regional Medical Associates Primary Care-Midway Campus)
• Insightful Soulutions Life Coach
• Sanquell-la'Shae Ivory
• Rollin B Jackson III, DMD
• Gloria Delores Johnson, COTA
• Shonda King, TRICHOLOGY
• Cheryl Elaine Lamb, AMFT
• Liberty Orthopaedic Associates

• Behavior Technician in Midway, GA
• Providers in Midway, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2022; 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.