Active NPI
Simone Jackson
- Physical Therapist
- Suwanee, GA
National Provider Identifier
1740846328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT015655
- Practice address
- 3455 Peachtree Pkwy Ste 206
Suwanee, GA 30024-9104 - Phone
- (678) 473-1081
- NPI assigned
- May 19, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT34564 | FL | |
| Physical Therapist | 225100000X | PT015655 | Primary |
Addresses
Primary practice location
3455 Peachtree Pkwy Ste 206
Suwanee, GA 30024-9104
Mailing address
6397 Lee Hwy
Chattanooga, TN 37421-2564
Phone (423) 238-3473
Other practice location 1
70 Pleasant Hill Ln
Tamarac, FL 33319-2442
Phone (954) 540-6880
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT34564 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637107200000",
"number": "1740846328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6397 LEE HWY",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374212564",
"telephone_number": "423-238-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3455 PEACHTREE PKWY STE 206",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300249104",
"telephone_number": "678-473-1081"
}
],
"practiceLocations": [
{
"address_1": "70 Pleasant Hill Ln",
"address_purpose": "LOCATION",
"city": "Tamarac",
"state": "FL",
"postal_code": "333192442",
"country_code": "US",
"telephone_number": "954-540-6880",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "SIMONE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-19",
"last_updated": "2021-11-17",
"certification_date": "2021-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT34564",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": "PT015655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.