Antonina Gabrielle Jackson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN140032 NP Issued in GA

Practice address

1800 Howell Mill Rd NW
Suite 450
Atlanta, GA 30318-2538

Phone

(404) 355-4393

Fax

(404) 419-9852

NPI assigned

Dec 29, 2010

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: afoster@erc-inc.directbygreenway.com

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.

• Empowerment Resource Center, Inc.

  • Clinic/Center
  • Atlanta, GA
  • NPI 1235469875
  Medicare reassignment NPD
• Van Meter Pediatric Endocrinology

  • Pediatric Endocrinology Physician
  • Atlanta, GA
  • NPI 1487967360
  NPD (past)

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

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1760786156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HOWELL MILL RD NW",
            "address_2": "SUITE 450",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303182538",
            "telephone_number": "404-355-4393",
            "fax_number": "404-419-9852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 HOWELL MILL RD NW",
            "address_2": "SUITE 450",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303182538",
            "telephone_number": "404-355-4393",
            "fax_number": "404-419-9852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTONINA",
        "middle_name": "GABRIELLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-29",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN140032 NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anee Sophia Jackson, MD
• Angela Denise Jackson, LPC
• Anna Jackson, PAA
• Anthwan Jackson, CNIM
• Antoine Trevor Jackson, LAPC
• Antonio Terell Jackson
• Areana Jackson
• Ashli Jackson, NP
• Brendan Robert Jackson, M.D.
• Brittany Jessica Jackson, NP

• Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.