MRS. SHONTAY JACKSON (NPI# 1851910897) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851910897 |
| Entity Type | Individual |
| Full Name | MRS. SHONTAY JACKSON |
| Other Name | SHONTAY ACKERSON |
| Credential | CPT |
| Practice Address |
4600 Rockbridge Rd Ste A Stone Mountain GA 30083-7312 |
| Mailing Address |
198 N Mcdonough St Jonesboro GA 30236-3665 |
| Practice Telephone | 8884846776 |
| Mailing Telephone | 8884846776 |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2020-05-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 146N00000X | Emergency Medical Technician, Basic | 448156 | CA | Emergency Medical Service Providers |
| Y | 246RP1900X |
Technician, Pathology Specialization: Phlebotomy |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
F07191809 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4600 ROCKBRIDGE RD STE A |
| City | STONE MOUNTAIN |
| State | GA |
| Zip Code | 30083-7312 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| 1710403431 | Trans Med Ems,llc | Ambulance | 4683 Redan Rd, Stone Mountain, GA 30083 | 2017-08-15 |
| 1447770482 | Dispatched Angels Home Care | In Home Supportive Care | 619 El Prado Court, Stone Mountain, GA 30083 | 2017-06-21 |
| 1396191086 | Suzanne Carter | Chore Provider | 1036 Allgood Rd, Stone Mountain, GA 30083 | 2016-05-11 |
| 1437520087 | Meaza Dada | Pharmacist | 1043 Thornwoode Lane, Stone Mountain, GA 30083 | 2015-10-08 |
| 1427436500 | Raeanne Elizabeth Gialanella | Occupational Therapist | 5839 Memorial Drive, Stone Mountain, GA 30083 | 2015-05-11 |
| 1265829824 | Latore Williams | Licensed Practical Nurse | 5300 Ridge Forest Drive, Stone Mountain, GA 30083 | 2015-04-22 |
| 1144625922 | Granville Theodore Freeman IIi | Counselor | 5000 Brittany Drive, Stone Mountain, GA 30083 | 2014-10-23 |
| 1588974208 | Terri R Collins | Counselor | 1020 Strap Hinge Trail, Stone Mountain, GA 30083 | 2010-10-15 |
| 1104064815 | Vistas Medical Center,pc | Clinic/Center | 5329 Memorial Dr Ste A, Stone Mountain, GEORGIA 30083 | 2009-02-03 |
| Find all providers in zip 30083 | ||||
| Taxonomy Code | 246RP1900X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Technician, Pathology |
| Specialization | Phlebotomy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770133936 | Deedgra Albert | Technician, Pathology | 4013 Creek Station Ln, Stone Mountain, GA 30083-7004 | 2019-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619576485 | Angels Mobile Phlebotomy Services LLC | Technician, Pathology | 185 Kirby Ln, Athens, GA 30606-1683 | 2020-10-22 |
| 1164021101 | Marquetta Nolbert | Technician, Pathology | 665 Castlebrooke Way, Lawrenceville, GA 30045-2665 | 2020-10-21 |
| 1528666518 | Shmeika Wilcox | Technician, Pathology | 3608 Stone Rd Sw, Atlanta, GA 30331-5306 | 2020-10-13 |
| 1972101913 | Revonia Lynn | Technician, Pathology | 4630 Rolling Brook Ct, Union City, GA 30291-6524 | 2020-10-12 |
| 1598362279 | Sheryl White | Technician, Pathology | 574 Scotland Dr, Dallas, GA 30132-2625 | 2020-10-06 |
| 1720685449 | Dominique Hyatt | Technician, Pathology | 1414 Ericas Pointe Dr, Winder, GA 30680-8006 | 2020-10-06 |
| 1922610799 | Mccane Labs LLC | Technician, Pathology | 1546a Rocky Creek Rd Ste A, Macon, GA 31206-3581 | 2020-08-21 |
| 1063036051 | Kianna Tymoria Boone | Technician, Pathology | 608 S Lee St, Fitzgerald, GA 31750-3217 | 2020-06-04 |
| 1568086031 | Antarnisear Brantley | Technician, Pathology | 311 Scott St Sw Apt 118, Atlanta, GA 30311-1814 | 2020-06-01 |
| 1568085330 | Monya Moreland | Technician, Pathology | 1008 Tree Terrace Pkwy, Austell, GA 30168-5544 | 2020-05-27 |
| Find all providers with the same taxonomy | ||||
| City | STONE MOUNTAIN |
| Zip Code | 30083 |
Please comment or provide details below to improve the information on MRS. SHONTAY JACKSON.
| 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.