Roger Lee Jackson II

Primary specialty

Intermediate Emergency Medical TechnicianTaxonomy code 146M00000X

License

40076 Issued in GA

Practice address

713 Clifton Rd SE
Atlanta, GA 30316-2229

Phone

(404) 246-5444

NPI assigned

Apr 20, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Caretakers EMS

  • Land Ambulance
  • Atlanta, GA
  • NPI 1790307049
  NPD Authorized official

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1881214872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 CLIFTON RD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303162229",
            "telephone_number": "404-246-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 CLIFTON RD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303162229",
            "telephone_number": "404-246-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROGER",
        "middle_name": "LEE",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146M00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": "GA",
            "license": "40076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Atlanta",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "713 Clifton Rd SE",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303162229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Denise Jackson, DSW, LMSW
• Nicolette Jackson
• Phillip Gaynor Jackson, D.O.
• Ramsey Elliott Jackson, M.D.
• Reginald Roberts Jackson, M.D.
• Ryan Theron Jackson
• Samuel Lee Jackson
• Shamika Jackson, RN
• Stefanie Charisse Jackson, LMFT
• Stephane Lea Jackson, LMT, CCT

• Intermediate Emergency Medical Technician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Intermediate Emergency Medical Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.