Active NPI
Mary Sonya Jackson
- Contractor
- Acworth, GA
National Provider Identifier
1922605690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- NTO15850
- Practice address
- 5480 Hedge Brooke Pointe NW
Acworth, GA 30101-7142 - Phone
- (404) 960-5486
- NPI assigned
- Oct 6, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | NTO15850 | ||
| Peer Specialist | 175T00000X | |||
| Contractor | 171W00000X | NTO15850 | GA | Primary |
Addresses
Primary practice location
5480 Hedge Brooke Pointe NW
Acworth, GA 30101-7142
Mailing address
5480 Hedge Brooke Pointe NW
Acworth, GA 30101-7142
Phone (404) 960-5486
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000000 | Other | GA | N/A |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NTO15850 | GA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601942400000",
"number": "1922605690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5480 HEDGE BROOKE POINTE NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301017142",
"telephone_number": "404-960-5486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5480 HEDGE BROOKE POINTE NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301017142",
"telephone_number": "404-960-5486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "SONYA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-06",
"last_updated": "2020-10-06",
"certification_date": "2020-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": null,
"license": "NTO15850",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "GA",
"license": "NTO15850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "N/A",
"identifier": "00000000",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
- J Chappell MD PC (Acworth Procedural Dermatology)
- J&F Solutions Management Group, LLC. (Mobility Cares)
- Kevin Justin Jablonsky, RNFA
- Jackson Family Therapy and Counseling
- Heather Jackson, MS, CCC-SLP
- Channelle Ananda Jacques-Louis
- Shirley May James, LMT
- Stephanie Jameson
- Jamestown Holdings (Interim Healthcare of Paulding County)
- Jasmine West (Hope Stone Services)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.