Individual provider Active NPI

Devon Nobis Jackoniski, PA

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1891760757
Registry record updated May 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003657 Issued in GA
Practice address
5671 Peachtree Dunwoody Rd NE
Suite 700
Atlanta, GA 30342-5000
Phone
(404) 847-9999
Fax
(404) 531-8466
NPI assigned
Feb 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 003657 GA Primary

Addresses

Primary practice location

5671 Peachtree Dunwoody Rd NE
Suite 700
Atlanta, GA 30342-5000

Mailing address

5671 Peachtree Dunwoody Rd NE
Suite 700
Atlanta, GA 30342-5000
Phone (404) 847-9999

Other names 1

  • Devon Nobis Other name

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)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Peachtree Orthopaedic Clinic PA Past Accepting new patients
Resurgens, LLC PastSince Mar 1, 2022 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275004800000",
    "number": "1891760757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5671 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303425000",
            "telephone_number": "404-847-9999",
            "fax_number": "404-531-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5671 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303425000",
            "telephone_number": "404-847-9999",
            "fax_number": "404-531-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKONISKI",
        "first_name": "DEVON",
        "middle_name": "NOBIS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-22",
        "last_updated": "2010-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEVON",
            "last_name": "NOBIS",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; 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.