MICHAEL S. JACKSON, MD, PC (NPI# 1164745782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164745782 |
| Entity Type | Organization |
| Organization Name | MICHAEL S. JACKSON, MD, PC |
| Other Organization Name | YOUR PERSONAL PHYSICIAN |
| Practice Address |
701 E 2nd Ave Sw Suite C Rome GA 30161-6148 |
| Mailing Address |
Po Box 40 Silver Creek GA 30173-0040 |
| Practice Telephone | 7062669090 |
| Practice Fax Number | 7062048797 |
| Mailing Telephone | 7062669090 |
| Mailing Fax Number | 7062048797 |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2011-01-20 |
| Authorized Official Name | DR. MICHAEL S JACKSON (PRESIDENT) |
| Authorized Official Telephone | 7062669090 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 055376 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | MEDICARE PTAN | 08BBRKT | 01 |
| MEDICARE INDIVIDUAL NPI | 1306830062 | 01 |
| Other Name | Type Code |
|---|---|
| Your Personal Physician | Doing Business As Name - Organization |
| Street Address |
701 E 2ND AVE SW SUITE C |
| City | ROME |
| State | GA |
| Zip Code | 30161-6148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225583594 | Ashley Law Ward | Counselor | 701 E 2nd Ave Sw, Suite A, Rome, GA 30161-6148 | 2016-08-16 |
| 1598110843 | Kimberly Butler | Social Worker | 701 E 2nd Ave Sw, Rome, GA 30161-6148 | 2016-04-24 |
| 1295101095 | Ashley Alexander Duke | Counselor | 701 E 2nd Ave Sw, Suite A, Rome, GA 30161-6148 | 2015-08-15 |
| 1558756049 | Amanda Deloach Penney, Lpc | Counselor | 701 E 2nd Ave Sw, Suite A, Rome, GA 30161-6148 | 2015-04-01 |
| 1568894095 | Amanda Penney | Counselor | 701 E 2nd Ave Sw, Suite A, Rome, GA 30161-6148 | 2013-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265069256 | Three Rivers Housing and Development Corporation | Chore Provider | 326 W. 9th St, Rome, GA 30161 | 2020-03-27 |
| 1144865957 | Eric Alan Fuller | Audiologist-Hearing Aid Fitter | 700 East 2nd Street, Suite C, Rome, GA 30161 | 2019-11-15 |
| 1003394883 | Cindy V Shelton | Health Educator | 204 E 1st Ave, Rome, GA 30161 | 2018-08-02 |
| 1083153597 | Julie Oglesby Allen | Counselor | 1 S Broad St Sw Ste 5, Rome, GA 30161 | 2017-02-16 |
| 1902299530 | Michael Thomas Phillips | Pharmacist | 2005 Maple Street, Rome, GA 30161 | 2015-03-06 |
| 1407259112 | Angela Smith | Community/Behavioral Health | 109 John Maddox Suite 200, Rome, GA 30161 | 2014-10-08 |
| 1215344379 | Nancy Patel | Pharmacist | 1421 North Broad St, Rome, GA 30161 | 2014-07-21 |
| 1821336629 | Wendy Pence | Nurse Practitioner | 3001 Turner Mccall Blvd, Rome, GA 30161 | 2013-01-29 |
| 1558526202 | Marilyn Teresa Ringstaff | Registered Nurse | 1513 Dean St., Rome, GA 30161 | 2008-07-22 |
| 1134310147 | Reneka L Dobbs-jackson | Family Medicine | 420 E 2nd Ave Ste 103, Rome, GA 30161 | 2007-08-05 |
| Find all providers in zip 30161 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447602347 | Tobias Jakobus Wallbrecher | Family Medicine | Via Domenico Silveri 30, Rome, ITALY 00165 | 2016-07-05 |
| 1346648250 | Free Clinic of Rome Georgia Inc | Family Medicine | 101-b John Maddox Drive, Rome, GA 30165-1419 | 2014-12-09 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1477723120 | Michael Edward Gonsalves | Family Medicine | 4159 Martha Berry Hwy Nw, Rome, GA 30165-7705 | 2008-03-10 |
| 1013108661 | Alexis Ann Eckard | Family Medicine | 255 W 5th Street, Suite 300, Rome, GA 30165 | 2007-08-08 |
| 1134310147 | Reneka L Dobbs-jackson | Family Medicine | 420 E 2nd Ave Ste 103, Rome, GA 30161 | 2007-08-05 |
| 1265502926 | Thomas H. Pierzchala, M.d., P.C. | Family Medicine | 304a E 2nd Ave, Rome, GA 30161-3222 | 2006-11-09 |
| 1023198066 | Camille Dillard Do Health & Wellness PC | Family Medicine | 900 Erie Blvd W, Rome, NY 13440-2904 | 2006-10-16 |
| 1063504710 | Cheryl Reinhardt | Family Medicine | 5865 New Calhoun Hwy Ne, Rome, GA 30161-8253 | 2006-09-29 |
| 1619086857 | S. T. Moss, M.d., P.C. | Family Medicine | 2016 Redmond Cir Nw, Rome, GA 30165-1322 | 2006-08-30 |
| Find all providers in ROME | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.