Jackson L Gates, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

038767 Issued in GA

Practice address

1880 Lancaster Drive
Conyers, GA 30013-6433

Phone

(678) 591-6509

NPI assigned

Aug 1, 2006

Last updated

Aug 10, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prime Care & Pathology Inc

  dba Jackson L Gates

  • Primary Care Clinic/Center
  • Conyers, GA
  • NPI 1144977802
  Medicare reassignment NPD Authorized official
• Gates Rapid Diagnostic Laboratory of Atlanta

  • General Practice Physician
  • Atlanta, GA
  • NPI 1710284435
  Authorized official Same address or phone
• Jefferson Pain Clinic Inc

  • Pain Medicine Physician
  • Jefferson, GA
  • NPI 1710156393
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281398400000",
    "number": "1962418400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 CLEVELAND AVE SW",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303157129",
            "telephone_number": "404-763-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 LANCASTER DRIVE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136433",
            "telephone_number": "678-591-6509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATES",
        "first_name": "JACKSON",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "038767",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "038767",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Ross Gardner, D.C.
• Cathy Garey, LCSW
• Amanda Grace Garner-Patrick, LCSW
• Brittney Je'Nise Garrett, AGACNP-BC, RN
• Veronica E Garrett, M.D.
• Gayla Dillard MD PC
• Rose Gayle-Smith, N.P.
• T David Gbadebo, MD
• Genoa Healthcare LLC
• Gentle Touch Dental

• General Practice Physician in Conyers, GA
• Providers in Conyers, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; 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.