Individual provider Active NPI

Lonnie Jerome Jackson

  • Internal Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1851259071
Registry record updated Jul 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34168 Issued in TN
Practice address
975 E 3Rd St
Chattanooga, TN 37403-2173
Phone
(423) 778-7000
NPI assigned
Jan 15, 2026
Last updated
Jul 18, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 34168 TN Primary
Nurse Practitioner 363L00000X 41251 TN

Addresses

Primary practice location

975 E 3Rd St
Chattanooga, TN 37403-2173

Mailing address

624 Belle Vista Ave
Chattanooga, TN 37411-2801
Phone (252) 373-6996

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20260514001832 TN Practitioner - Nurse Practitioner 9436628997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

975 E 3Rd St
Chattanooga, TN 37403-2173

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41251TNMDNurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1768435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784332800000",
    "number": "1851259071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 BELLE VISTA AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374112801",
            "telephone_number": "252-373-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 E 3RD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032173",
            "telephone_number": "423-778-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LONNIE",
        "middle_name": "JEROME",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-01-15",
        "last_updated": "2026-07-18",
        "certification_date": "2026-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "34168",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "41251",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.