Active NPI
Miranda Jacko
- Massage Therapist
- Lithonia, GA
National Provider Identifier
1740159656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT015470
- Practice address
- 7245 Rockbridge Rd Ste 600
Lithonia, GA 30058-8615 - Phone
- (470) 415-0471
- NPI assigned
- Oct 30, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT015470 | GA | Primary |
Addresses
Primary practice location
7245 Rockbridge Rd Ste 600
Lithonia, GA 30058-8615
Mailing address
615 Oakview TRL
Stone Mountain, GA 30087-6611
Phone (470) 448-9452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT015470 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761782400000",
"number": "1740159656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 OAKVIEW TRL",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300876611",
"telephone_number": "470-448-9452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7245 ROCKBRIDGE RD STE 600",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300588615",
"telephone_number": "470-415-0471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKO",
"first_name": "MIRANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-30",
"last_updated": "2025-10-30",
"certification_date": "2025-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT015470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.