DR. CHARLES FREDERICK JACKSON III (NPI# 1629252184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629252184 |
| Entity Type | Individual |
| Full Name | DR. CHARLES FREDERICK JACKSON III |
| Credential | M.D. |
| Practice Address |
504 Redmond Rd Nw Rome GA 30165-1416 |
| Mailing Address |
221 Technology Pkwy Nw Rome GA 30165-1369 |
| Practice Telephone | 7062353855 |
| Practice Fax Number | 7062902382 |
| Mailing Telephone | 7622351000 |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2020-04-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
066188 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003122986H | 05 | |
| GA | 003122986A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457896839 | Charles Jackson | Counselor | 2911 Penick St, Shreveport, LA 71109-4337 | 2016-12-21 |
| 1043655681 | Charles D Jackson | Driver | 4856 W.12th, Suite 1, Cleveland, OH 44109-3424 | 2013-05-09 |
| 1437594553 | Charles Jackson | Social Worker | 18712 Quarry St, Riverview, MI 48193-4527 | 2013-05-02 |
| 1508154105 | Charles Gilbert Jackson Jr. | Psychiatry & Neurology | 88 Crescent St, Northampton, MA 01060-2115 | 2011-07-16 |
| 1457669848 | Charles Edward Jackson Jr. | Psychologist | 1407 Healing Water Lane, N.las Vegas, NV 89031 | 2010-09-20 |
| 1588994081 | Charles Dustin Jackson | Counselor | 5004 Nw 26th St, Oklahoma City, OK 73127-1722 | 2010-01-05 |
| 1508985250 | Charles Arthur Jackson Jr. | Chiropractor | 2455 E Hill Rd, Grand Blanc, MI 48439 | 2007-03-27 |
| 1760535926 | Charles Jackson | Podiatrist | 820 N Dalmont St, Hobbs, NM 88240-5214 | 2007-01-19 |
| 1982769840 | Charles Jackson | Dentist | 3540 82nd St, Jackson Heights, NY 11372-5159 | 2006-12-22 |
| 1437224813 | Charles Wesley Jackson Jr. | Psychologist | 2980 Washington Blvd, Cleveland Heights, OH 44118-2450 | 2006-11-21 |
| Street Address |
504 REDMOND RD NW |
| City | ROME |
| State | GA |
| Zip Code | 30165-1416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689676041 | Karen Jean Roberts | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2005-08-15 |
| 1003426537 | Hilarie Hincy Rankin | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2020-08-10 |
| 1689299000 | Phebe Nicole Hagins Wright | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2020-06-11 |
| 1124688270 | Zachary Carl Whitener | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2019-06-19 |
| 1255805180 | Amanda Lynn Preteroti | Physician Assistant | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2019-01-14 |
| 1245700731 | Marenda Celie Russell | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2018-11-28 |
| 1952870164 | Redmond Specialty Services, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2018-11-16 |
| 1568958429 | Lori Ann Brady | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2018-07-03 |
| 1558869404 | Robbie Leah Skinner | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2018-01-25 |
| 1477928448 | Tosha Michelle White | Nurse Practitioner | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2015-12-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
| Find all providers in zip 30165 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891068730 | Anand I Desai Md PC | Internal Medicine | 1819 Black River Blvd., Rome, NY 13440 | 2012-02-22 |
| 1699880237 | Apparao I Poonati | Internal Medicine | 509 N Washington St, Rome, NY 13440 | 2006-08-21 |
| 1891922498 | Kipp Slicker | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2009-06-22 |
| 1336357060 | Charles Brandon Baggett | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2007-05-18 |
| 1669537734 | Frank Durham Stegall | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2006-12-27 |
| 1275698235 | James Michael Ware | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2006-12-27 |
| 1225193303 | Robert Peter Styperek | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2006-12-27 |
| 1457416869 | Hector Rafael Picon | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2006-12-26 |
| 1649332420 | James Christopher Merritt | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2006-12-15 |
| 1982766630 | George Hunter Myers | Internal Medicine | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2006-12-15 |
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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.