Lewis W. Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

042294 Issued in GA

Practice address

2959 Sharpsburg McCollum Rd
Newnan, GA 30265-2297

Phone

(770) 502-2000

Fax

(770) 502-2009

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Piedmont Pediatric Physicians LLC

  • Pediatrics Physician
  • Newnan, GA
  • NPI 1447315742
  Medicare reassignment NPD

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1891779096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2959 SHARPSBURG MCCOLLUM RD",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652297",
            "telephone_number": "770-502-2000",
            "fax_number": "770-502-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2959 SHARPSBURG MCCOLLUM RD",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652297",
            "telephone_number": "770-502-2000",
            "fax_number": "770-502-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LEWIS",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "042294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000717131E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Itsmeannb,LLC
• Victoria Ivens, DPT
• Crista Jonte' Ivory, NP
• Elizabeth A. Jackson, NP-C
• Henry Jackson, DMD
• Malasia Jackson, RBT
• Mallory Charlene Jackson
• Melvin Jackson, NP
• Sandra Lynne Jackson, LPC
• Willandria S Jackson

• Pediatrics Physician in Newnan, GA
• Providers in Newnan, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.