MRS. NICHELLE JACKSON (NPI# 1972154722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972154722 |
| Entity Type | Individual |
| Full Name | MRS. NICHELLE JACKSON |
| Credential | MSN, NP-BC |
| Practice Address |
49 Jesse Hill Jr Dr Se Atlanta GA 30303-3049 |
| Mailing Address |
1052 Ashton Park Dr Lawrenceville GA 30045-7277 |
| Practice Telephone | 4042518921 |
| Mailing Telephone | 6789846020 |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
RN180557 | GA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 49 Jesse Hill Jr Dr Se, Atlanta, GA 303033049 | ||
| 49 Jesse Hill Jr Drive, Atlanta, GA 303033049 | ||
| 80 Jesse Hill Jr Dr Se, Atlanta, GA 303033031 |
| Street Address |
49 JESSE HILL JR DR SE |
| City | ATLANTA |
| State | GA |
| Zip Code | 30303-3049 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437155074 | Marc D Thames | Internal Medicine | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2005-06-27 |
| 1740806652 | Wesley Gordon | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-06-17 |
| 1073132981 | Kaitlin M O'sullivan | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-10 |
| 1902425051 | Sandip Kaur Minhas | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-09 |
| 1265061725 | Thinh Hoang Nguyen | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-06 |
| 1902435613 | Farina Shafqat | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-04 |
| 1083243919 | Monika Marie Sullivan | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-03 |
| 1811526627 | Jacob Harris Levy | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-03 |
| 1164051983 | Neha Shukla | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-03 |
| 1194353383 | Vidya Menon | Student in an Organized Health Care Education/Training Program | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2020-04-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811597461 | Nanoresearch, Inc | Point of Service | 58 Edgewood Ave Ne, Suite 122, Collabtech., Gsu, Atlanta, GA 30303 | 2020-10-31 |
| 1952917155 | Alesha Deshay Elbert | Behavior Technician | 206 Peachstreet Ne Suite 2200, Atlanta, GA 30303 | 2020-09-22 |
| 1033759386 | Mark Bush | Case Manager/Care Coordinator | 50 Hurt Plaza Se Suite 1108, Atlanta, GA 30303 | 2020-01-14 |
| 1053965855 | Patrice Munsel Henry | Nurse Practitioner | 80 Jessie Hill Drive Se, Atlanta, GA 30303 | 2019-07-30 |
| 1356826564 | United States Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 260 Peachtree Street Nw, Suite 2200, Office 2228, Atlanta, GA 30303 | 2018-10-03 |
| 1336645290 | Joseph Bahng | Student in an Organized Health Care Education/Training Program | 69 Jesse Hill Jr Drive Se, Glenn Building, 4th Floor - 412b, Atlanta, GA 30303 | 2018-03-31 |
| 1841704707 | Amber Peach LLC | Family Medicine | 260 Peachtree St Nw Suite 2200, Atlanta, GA 30303 | 2017-11-29 |
| 1447778089 | Jasmine Williams | Behavioral Analyst | 260 Peachtree Street Nw, Suite 2200, Atlanta, GA 30303 | 2017-09-05 |
| 1982138236 | Mahek Dossani | Behavior Technician | 260 Peachtree Street Nw, Suite 2200, Atlanta, GA 30303 | 2017-04-13 |
| 1255872420 | Alexis Annick Auger | Behavior Technician | 260 Peachtree St. Nw, Suite 2200, Atlanta, GA 30303 | 2017-03-20 |
| Find all providers in zip 30303 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346411667 | Harvey E Schuck | Emergency Medicine | 427 Brentwood Dr Ne, Atlanta, GA 30305-3204 | 2008-03-14 |
| 1639364011 | Srihari Rao Malempati | Emergency Medicine | 535 Trimble Lake Ct Ne, Atlanta, GA 30342-2481 | 2007-09-10 |
| 1487729992 | Lisa Tadayon | Emergency Medicine | 1000 John Fy Rd Ne, Atlanta, GA 30342-1606 | 2006-11-21 |
| 1598851636 | Model N/a Neway | Emergency Medicine | 3112 Pine Heights Dr Ne, Atlanta, GA 30324-2843 | 2006-10-05 |
| 1154439586 | Barbara D Nichols | Emergency Medicine | 1968 Peachtree Rd. Northeast, Atlanta, GA 30309 | 2006-08-27 |
| 1164480869 | Emerginet, LLC | Emergency Medicine | 235 Peachtree St Ne, North Tower, Suite 2100, Atlanta, GA 30303-1401 | 2006-05-02 |
| 1336564236 | James Patrick O'neal | Emergency Medicine | 2 Peachtree St Nw Fl 15, Suite 15-433, Atlanta, GA 30303-3142 | 2014-02-28 |
| 1427353861 | Suwanee Physicians, LLC | Emergency Medicine | 2151 Peachford Rd, Hospitalist Service, Atlanta, GA 30338-6534 | 2011-01-16 |
| 1972777209 | Piedmont Minor Emergency Clinic PC | Emergency Medicine | 3108 Piedmont Rd Ne, Atlanta, GA 30305-2513 | 2008-04-17 |
| 1902098916 | Todd Taylor | Emergency Medicine | 531 Asbury Cir, Hospital Annex-suite N340, Atlanta, GA 30322-1006 | 2007-08-14 |
| Find all providers in ATLANTA | ||||
Please comment or provide details below to improve the information on MRS. NICHELLE 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.