Active NPI
Amanda Jackson, ATC
- Athletic Trainer
- Marietta, GA
National Provider Identifier
1770017949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT003082
- Practice address
- 1269 Barclay Cir SE
Marietta, GA 30060-2903 - Phone
- (919) 370-0423
- NPI assigned
- Apr 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT003082 | GA | Primary |
| Athletic Trainer | 2255A2300X | LAT-2819 | NC |
Addresses
Primary practice location
1269 Barclay Cir SE
Marietta, GA 30060-2903
Mailing address
102 Wethersfield Dr
Cary, NC 27513-4965
Phone (919) 370-0423
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 |
|---|---|---|---|
| AT003082 | GA | MD | Athletic Trainer |
| LAT-2819 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492128000000",
"number": "1770017949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 WETHERSFIELD DR",
"city": "CARY",
"state": "NC",
"postal_code": "275134965",
"telephone_number": "919-370-0423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1269 BARCLAY CIR SE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300602903",
"telephone_number": "919-370-0423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AMANDA",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-14",
"last_updated": "2017-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT003082",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-2819",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.