Tiffani Dianne Jackson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

535 Riverstone Pkwy Ste 101
Canton, GA 30114-2566

Phone

(470) 863-3090

NPI assigned

Apr 20, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1710620356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GREENWOOD PARK WAY",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305348443",
            "telephone_number": "678-629-0537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 RIVERSTONE PKWY STE 101",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142566",
            "telephone_number": "470-863-3090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6505 Shiloh Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300051645",
            "country_code": "US",
            "telephone_number": "678-648-7644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIFFANI",
        "middle_name": "DIANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariam K. Ishaq, PA-C
• Rayllensons Itacy, P.A.
• Vladislav Ivanchenko, OD
• Jabez Wellness
• Leslie Schaad Jackson, FNP-C
• Brooke Ashley Jacobs, PHARM D
• Kenneth S Jago, MD
• Mariah James, DPT
• Janet L Jarrette, NP
• Erin Lynn Jarvis, M.S., C.G.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.