Gregory Jackson
Individual provider Active NPI Chiropractor · Hapeville, GA
NPI 1972179018 · NPPES record last updated May 30, 2021
Key facts
- NPI
- 1972179018
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIRO07189 (GA)
- Practice address
- 3640 S Fulton Ave Unit 1411
Hapeville, GA 30354-1770 - Phone
- (424) 284-9663
- NPI assigned
- May 30, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIRO07189 | GA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIRO07189 | GA | Yes |
Addresses
Primary practice location
3640 S Fulton Ave Unit 1411
Hapeville, GA 30354-1770
Mailing address
3640 S Fulton Ave Unit 1411
Hapeville, GA 30354-1770
Phone (424) 284-9663
Other providers in Hapeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.