Melinda W. Jackson, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT002649 Issued in GA

Practice address

1124 N Park St Ste M
Carrollton, GA 30117-2282

Phone

(770) 834-0873

Fax

(770) 834-6118

NPI assigned

Aug 20, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Carrollton Orthopaedic Clinic PC

  • Rheumatology Physician
  • Carrollton, GA
  • NPI 1356483747

  Occupational Therapist

  Medicare reassignment NPD
• Acts

  • Speech-Language Pathologist
  • Fayetteville, GA
  • NPI 1093253395

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1972750073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE STE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174402",
            "telephone_number": "770-834-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 N PARK ST STE M",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172282",
            "telephone_number": "770-834-0873",
            "fax_number": "770-834-6118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Shoreline Cir",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302635940",
            "country_code": "US",
            "telephone_number": "770-304-3880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELINDA",
        "middle_name": "W.",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT002649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Ivester, LPC
• Tondra Ivey, NP-C
• Jack W Miller
• Holly M Jackson, NP
• Janet Jackson, LPC
• Purdy Jackson
• Savannah Bryanna Jackson, NP
• Rocio Jacobo Lafrance, DMD
• Lisa Marie Jacobson, MA, LPC, NCC
• James William Campbell

• Occupational Therapist in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.