BRANDON JACKSON (NPI# 1083163521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083163521 |
| Entity Type | Individual |
| Full Name | BRANDON JACKSON |
| Practice Address |
122 Lanier Dr 322c Statesboro GA 30458-0804 |
| Mailing Address |
3360 Ohara Dr N Macon GA 31206-3832 |
| Practice Telephone | 4783618736 |
| Mailing Telephone | 4782168765 |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2016-09-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275046153 | Brandon Lamarr Jackson | Home Health Aide | 400 Brunswick St, Mooresville, NC 28115-2246 | 2017-11-14 |
| 1881030310 | Brandon Christopher Jackson | Military Health Care Provider | 6810 Camphor Ln, San Diego, CA 92139 | 2013-05-10 |
| 1861753949 | Brandon Joshua Jackson | Dentist | 70 Virginia Ave, Staten Island, NY 10305-1748 | 2012-06-05 |
| 1952340671 | Brandon Leroy Jackson | Physical Therapist | 4765 S. Durango Dr., Ste 106, Las Vegas, NV 89147 | 2006-06-06 |
| 1457994634 | Brandon Jackson | Rehabilitation Practitioner | 1873 W 54th St, Los Angeles, CA 90062-2604 | 2019-10-21 |
| 1427611151 | Brandon Clark Jackson | Social Worker | 42-77 65th Place, Woodside, NY 11377-5054 | 2019-04-18 |
| 1831658640 | Brandon Thomas Jackson | Plastic Surgery | 251 E Huron St, Chicago, IL 60611-3055 | 2019-03-19 |
| 1164952644 | Brandon Scott Jackson | Behavior Technician | 1200 W South Boulder Rd Ste 204, Lafayette, CO 80026-2833 | 2017-06-15 |
| 1578896031 | Brandon T. Jackson | Chiropractor | 1258 Bryan Rd, O Fallon, MO 63366-3771 | 2009-09-15 |
| Street Address |
122 LANIER DR 322C |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-0804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093327462 | Lauryn Ashleigh Metzdorf | Student in an Organized Health Care Education/Training Program | 816 S Main St Apt 164, Statesboro, GA 30458-3476 | 2020-08-18 |
| 1720615263 | Deborah Timmons Hill | Student in an Organized Health Care Education/Training Program | 124 Savannah Ave Ste 1c, Statesboro, GA 30458-7149 | 2020-03-25 |
| 1841738309 | Mason Dean Worsham | Student in an Organized Health Care Education/Training Program | 117 Hawthorne Rd, Statesboro, GA 30458-6003 | 2017-02-05 |
| 1427592765 | Scarlet Gabrielle Shumate | Student in an Organized Health Care Education/Training Program | 1332 Southern Dr., Statesboro, GA 30461 | 2016-12-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| 1437559333 | Catherine Mcculley | Student in an Organized Health Care Education/Training Program | 590 Herty Dr, Statesboro, GA 30460-0001 | 2014-08-27 |
| 1447659305 | Christopher Patrick Tomczyk | Student in an Organized Health Care Education/Training Program | 338 Langston Chapel Rd, Statesboro, GA 30458-2478 | 2014-08-16 |
| 1659908184 | Shelby Lynn Somers | Student in an Organized Health Care Education/Training Program | 124 Savannah Ave Ste 1c, Statesboro, GA 30458-7149 | 2020-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912508540 | Robert Owen Calvert IIi | Student in an Organized Health Care Education/Training Program | 10734 Bossier Dr, Johns Creek, GA 30022-7977 | 2020-11-02 |
| 1194323469 | Kathlynn Barber | Student in an Organized Health Care Education/Training Program | 248 Sunset Ridge Dr, Newnan, GA 30263-7704 | 2020-10-09 |
| 1063019917 | Shayla Robinson | Student in an Organized Health Care Education/Training Program | 1887 Hudson Xing Apt 9, Tucker, GA 30084-5661 | 2020-10-05 |
| 1639786460 | Clarissa Chamorro | Student in an Organized Health Care Education/Training Program | 840 Old Alabama Rd Sw, Mableton, GA 30126-4108 | 2020-09-25 |
| 1417563909 | Josephine Almanzar | Student in an Organized Health Care Education/Training Program | 199 Armour Dr Ne Ste E, Atlanta, GA 30324-3973 | 2020-09-20 |
| 1942816962 | Kofi Darkwa Seffah | Student in an Organized Health Care Education/Training Program | 1199 Prince Ave #70, 1270 Prince Ave Suite 201, Athens, GA 30606 | 2020-09-16 |
| 1487269338 | Nhu Ai Thi Vo | Student in an Organized Health Care Education/Training Program | 5295 Locomotive Ln, Norcross, GA 30071-2751 | 2020-09-08 |
| 1669087516 | Nurin Ghazzawi | Student in an Organized Health Care Education/Training Program | 1953 Valley Ridge Ln, Duluth, GA 30096-6024 | 2020-09-08 |
| 1871107029 | Ashlie Simmons | Student in an Organized Health Care Education/Training Program | 40 Hardwood Forest Cir, Brunswick, GA 31525-4738 | 2020-09-04 |
| 1427660166 | Kassie Howard | Student in an Organized Health Care Education/Training Program | 2601 Northlake Dr # 1722, Suwanee, GA 30024-2942 | 2020-08-22 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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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.