NPIMap

Individual provider Active NPI

Carroll Davis Jackson, APRN

  • Family Nurse Practitioner
  • Adel, GA
National Provider Identifier
1982111704
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP167907 Issued in GA
Practice address
172 MJ Taylor Rd
Adel, GA 31620-3497
Phone
(229) 896-8500
NPI assigned
Jan 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP167907 GA Primary

Addresses

Primary practice location

172 MJ Taylor Rd
Adel, GA 31620-3497

Mailing address

907 18TH St E Ste 400
Tifton, GA 31794-3684
Phone (229) 353-3422

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address carroll.jackson@trhs.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200325002168 GA Practitioner - Nurse Practitioner 0547698508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

150 MJ Taylor Rd
Adel, GA 31620-3497
Phone (229) 896-8440

172 MJ Taylor Rd
Adel, GA 31620-3497
Phone (229) 896-8500

Hospital & facility affiliations

  • Southwell Medical, a Campus of TRMC Hospital, Adel, GA, CCN 110101

Merit-based Incentive Payment System (MIPS)

Final score
81.02 of 100Reported as group
Quality
57.87
Promoting interoperability
100
Improvement activities
40
Cost
75.97

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP167907GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System, Inc. Current Accepting new patients
Tift Regional Health System Inc Current Accepting new patients
Tift Regional Health System Inc CurrentSince Mar 18, 2020 Accepting new patients
Tift Regional Health System Inc CurrentSince Mar 18, 2020 Accepting new patients
Premiercare Omega PastSince Mar 29, 2020 Accepting new patients
Omega Family Medicine, LLC Past Accepting new patients

Locations

172 Mj Taylor Rd
Adel, GA 31620
Phone (229) 896-3424

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

907 18th St E
Ste 400
Tifton, GA 31794

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1982111704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E STE 400",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943684",
            "telephone_number": "229-353-3422",
            "fax_number": "229-353-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 MJ TAYLOR RD",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316203497",
            "telephone_number": "229-896-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARROLL",
        "middle_name": "DAVIS",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-02",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "NP167907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carroll.jackson@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "172 Mj Taylor Rd",
            "city": "Adel",
            "state": "GA",
            "country_code": "US",
            "postal_code": "316203497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Adel, GA

Sources for this page

Verify at the official NPI Registry.