Logan J Jackson, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

2025-03621 Issued in NC

Practice address

3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117

Phone

(704) 332-1291

NPI assigned

Mar 25, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Diagnostic Radiology

Education

Medical University of South Carolina College of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Virginia Physicians GroupGroup PAC ID 4880590728, 1,685 clinicians

Mecklenburg Radiology Associates PAGroup PAC ID 6800789587, 95 clinicians

University of Virginia Imaging LLCGroup PAC ID 2567479405, 82 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Virginia Medical Center Hospital, Charlottesville, VA, CCN 490009
• Uva Health Culpeper Medical Center Hospital, Culpeper, VA, CCN 490019
• Uva Health Haymarket Medical Center Hospital, Haymarket, VA, CCN 490144
• Uva Health Prince William Medical Center Hospital, Manassas, VA, CCN 490045
• Novant Health Huntersville Medical Center Hospital, Huntersville, NC, CCN 340183

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ljackson670515@direct.healthsystem.virginia.edu

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.

• Mecklenburg Radiology Associates, P.a.

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1295790657

  VA

  Medicare reassignment Care Compare group NPD
• University of Virginia Imaging, LLC

  • Diagnostic Radiology Physician
  • Charlottesville, VA
  • NPI 1720233596
  Medicare reassignment Care Compare group NPD
• University of Virginia Physicians Group

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Charlottesville, VA
  • NPI 1033138250
  Medicare reassignment Care Compare group NPD
• University of Virginia Imaging, LLC

  • Radiology Clinic/Center
  • Charlottesville, VA
  • NPI 1033439500

  Diagnostic Radiology

  NPD
• University of Virginia Imaging, LLC

  • Radiology Clinic/Center
  • Charlottesville, VA
  • NPI 1700545928

  Diagnostic Radiology

  NPD
• Uva Outpatient Imaging Centreville LLC

  • Physiological Laboratory
  • Gainesville, VA
  • NPI 1972455624
  NPD
• Uva Outpatient Imaging Culpeper, LLC

  • Radiology Clinic/Center
  • Culpeper, VA
  • NPI 1841825593

  Diagnostic Radiology

  NPD

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

• The Presbyterian Hospital

  • General Acute Care Hospital
  • Huntersville, NC
  • NPI 1346291309
  Care Compare affiliation
• Rector & Visitors of the University of Virginia

  • General Acute Care Hospital
  • Charlottesville, VA
  • NPI 1780630608
  Care Compare affiliation
• Uva Culpeper Medical Center

  • General Acute Care Hospital
  • Culpeper, VA
  • NPI 1669538047
  Care Compare affiliation
• Uva Prince William Medical Center

  • General Acute Care Hospital
  • Haymarket, VA
  • NPI 1124369137
  Care Compare affiliation
• Uva Prince William Medical Center

  • General Acute Care Hospital
  • Manassas, VA
  • NPI 1417005760
  Care Compare affiliation

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1740817261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221249",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282221249",
            "telephone_number": "704-332-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR STE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112117",
            "telephone_number": "704-332-1291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 Lee St",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229083055",
            "country_code": "US",
            "telephone_number": "434-924-9400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "251 E Huron St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606113055",
            "country_code": "US",
            "telephone_number": "312-695-4447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LOGAN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-25",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": "LL84285",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101285232",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "125077323",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2025-03621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelcy Leigh Jackson, MD
• Keneisha Jackson
• Keosha Jackson
• Kieondra Jackson
• Lauren Huber Jackson
• Malaka Baharah Jackson, M.D.
• Natalie Ann Jackson
• Nola Ann Jackson
• Pamela Carol Jackson, NP
• Patrick Jackson

• Diagnostic Radiology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Diagnostic Radiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.