Active NPI
Craig Lebern Jackson, RN
- Religious Nonmedical Nursing Personnel
- Suwanee, GA
National Provider Identifier
1992926000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Religious Nonmedical Nursing Personnel
- License
- 148363
- Practice address
- 4297 Wyndam Hill Dr
Suwanee, GA 30024-6525 - Phone
- (404) 294-0499
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Religious Nonmedical Nursing Personnel | 374T00000X | 148363 | GA | Primary |
Addresses
Primary practice location
4297 Wyndam Hill Dr
Suwanee, GA 30024-6525
Mailing address
4297 Wyndam Hill Dr
Suwanee, GA 30024-6525
Phone (404) 294-0499
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 148363 | GA | MD | Religious Nonmedical Nursing Personnel |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992926000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4297 WYNDAM HILL DR",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300246525",
"telephone_number": "404-294-0499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4297 WYNDAM HILL DR",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300246525",
"telephone_number": "404-294-0499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CRAIG",
"middle_name": "LEBERN",
"name_prefix": "Prof.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "374T00000X",
"taxonomy_group": "",
"desc": "Religious Nonmedical Nursing Personnel",
"state": "GA",
"license": "148363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.