Active NPI
Hazel Anita Jackson, MN, RN, APRN,BC
- Medical-Surgical Registered Nurse
- Decatur, GA
National Provider Identifier
1770510802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical-Surgical Registered Nurse
- License
- R084397
- Practice address
- 1670 Clairmont Rd
Decatur, GA 30033-4004 - Phone
- (404) 321-6111
- Fax
- (404) 327-4972
- NPI assigned
- Jun 26, 2006
- 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 |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | R084397 | GA | Primary |
Addresses
Primary practice location
1670 Clairmont Rd
Decatur, GA 30033-4004
Mailing address
1429 Oak Knoll Dr NE
Conyers, GA 30012-4751
Phone (770) 918-1558
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R084397 | GA | MD | Medical-Surgical Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770510802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1429 OAK KNOLL DR NE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300124751",
"telephone_number": "770-918-1558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334004",
"telephone_number": "404-321-6111",
"fax_number": "404-327-4972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HAZEL",
"middle_name": "ANITA",
"name_prefix": "Ms.",
"credential": "MN, RN, APRN,BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "GA",
"license": "R084397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.