Individual provider Active NPI

Jackson Thomas Londeree, DO

  • Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1730523887
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
78075 Issued in GA
Practice address
1400 Tullie Rd NE FL 2
Atlanta, GA 30329-2309
Phone
(404) 785-5437
Fax
(404) 785-9071
NPI assigned
Apr 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 78075 GA Primary

Addresses

Primary practice location

1400 Tullie Rd NE FL 2
Atlanta, GA 30329-2309

Mailing address

1400 Tullie Rd NE FL 2
Atlanta, GA 30329-2309
Phone (404) 785-5437

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address choa@choa.gadirect.net

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201019002040 GA Practitioner - Pediatric MedicinePractitioner - Nephrology 5799076717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Nephrology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Choa Multispecialty, LLCGroup PAC ID 7719126820, 35 clinicians

Practice addresses (Care Compare)

1400 Tullie Rd NE
Suite 210
Atlanta, GA 30329-2309
Phone (404) 785-5437

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
78075GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Egleston Pediatric Group Pediatrics Current Accepting new patients
Choa Hospital Based, LLC Pediatrics CurrentSince Jul 3, 2020 Accepting new patients
Choa Multispecialty, LLC Pediatrics CurrentSince Jul 3, 2020 Accepting new patients
Egleston Children'S Hospital at Emory University, Inc. Past Accepting new patients
Arthur M. Blank Hospital, Inc. Past Accepting new patients

Locations

2015 Upper Gate Dr NE
Fl 5
Atlanta, GA 30322
Phone (404) 727-2469

1400 Tullie Rd NE
Ste 210
Atlanta, GA 30329
Phone (404) 785-0122

1405 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 785-1112

1001 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 785-2008

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1730523887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 TULLIE RD NE FL 2",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292309",
            "telephone_number": "404-785-5437",
            "fax_number": "404-785-9071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 TULLIE RD NE FL 2",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292309",
            "telephone_number": "404-785-5437",
            "fax_number": "404-785-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONDEREE",
        "first_name": "JACKSON",
        "middle_name": "THOMAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-19",
        "last_updated": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "78075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "1400 Tullie Rd NE Fl 2",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303292309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.