ELBERT E JACKSON, DDS, PC (NPI# 1871652172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871652172 |
| Entity Type | Organization |
| Organization Name | ELBERT E JACKSON, DDS, PC |
| Practice Address |
200 Gleaves St Suite C Madison TN 37115-2154 |
| Practice Telephone | 6158591881 |
| Practice Fax Number | 6158657723 |
| Mailing Telephone | 6158591881 |
| Mailing Fax Number | 6158657723 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ELBERT E JACKSON (OWNER) |
| Authorized Official Telephone | 6158591881 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
DS2474 | TN | Dental Providers |
| Street Address |
200 GLEAVES ST SUITE C |
| City | MADISON |
| State | TN |
| Zip Code | 37115-2154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942295662 | Sara J Patterson | Pediatrics | 200 Gleaves St, Ste A, Madison, TN 37115-2154 | 2005-09-19 |
| 1487952917 | Mary Kathryn Oliver | Nurse Practitioner | 200 Gleaves St, Suite A, Madison, TN 37115-2176 | 2011-03-08 |
| 1407903362 | Sarah Marshall Mantle | Pediatrics | 200 Gleaves St, Suite A, Madison, TN 37115-2154 | 2007-01-04 |
| 1356419055 | Elbert E Jackson | Dentist | 200 Gleaves St, Suite C, Madison, TN 37115-2154 | 2006-12-01 |
| 1619989894 | Karen S Meredith | Pediatrics | 200 Gleaves St, Suite 200, Madison, TN 37115-2154 | 2006-08-13 |
| 1194700187 | Patricia F Robinson | Pediatrics | 200 Gleaves St, Suite A, Madison, TN 37115-2154 | 2005-12-13 |
| 1386631729 | Mary Heather Johnson | Pediatrics | 200 Gleaves St, Ste A, Madison, TN 37115-2154 | 2005-09-30 |
| 1174519284 | Dina H Mishu | Pediatrics | 200 Gleaves St, Suite A, Madison, TN 37115-2154 | 2005-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023675212 | Kennedy Wayne Germany Jr. | Specialist/Technologist | 813 Seashell Cove, Madison, TN 37115 | 2019-05-22 |
| 1497211387 | Latasha Monique Williams | Social Worker | Patriot Place (va), 314 Williams Avenue, Ste. 100, Madison, TN 37115 | 2019-02-15 |
| 1659866481 | Amanda Elliott | Pharmacist | 109 Gallatin Rd, Madison, TN 37115 | 2018-06-25 |
| 1760938492 | Larry Cox | Case Manager/Care Coordinator | 620 S. Gallatin Pike, Madison, TN 37115 | 2016-09-01 |
| 1407202799 | National Vision, Inc. | Technician/Technologist | 1785 Gallatin Pike N, Madison, TN 37115 | 2016-05-05 |
| 1992190193 | Emily Tibbs | Case Manager/Care Coordinator | 620 Gallatin Pike, Madison, TN 37115 | 2015-04-03 |
| 1164829982 | Laura Boswell | Case Manager/Care Coordinator | 620 Gallatin Pike South, Madison, TN 37115 | 2014-11-21 |
| 1720498058 | Edward Andrew Roberts | Chiropractor | 1710 Gallatin Pike N, Madison, TN 37115 | 2014-05-08 |
| 1700296217 | Lamonia Merritt | Student in an Organized Health Care Education/Training Program | 645 Cheyenne Blvd, Madison, TN 37115 | 2014-05-06 |
| 1629497656 | Corey Joseph Cloud | Dentist | 500 Lentz Dr Ste 40, Madison, TN 37115 | 2014-04-07 |
| Find all providers in zip 37115 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154555282 | Orthodontic Care of Georgia | Dentist | 1690 Eatonton Rd, Madison, GA 30650-4628 | 2009-05-04 |
| 1336382845 | James Russell Durham | Dentist | 7559c Highway 72 West, Suite 105, Madison, AL 35758-8812 | 2009-04-14 |
| 1851507248 | William Koenig | Dentist | 2040 Hubbard Rd, Madison, OH 44057-2566 | 2007-05-15 |
| 1497809537 | Marion Garr Doyle | Dentist | 624 W Due West Ave, Madison, TN 37115-4402 | 2007-01-23 |
| 1942358635 | Damian O. Fennig | Dentist | 5520 Medical Cir, Madison, WI 53719-1226 | 2007-01-08 |
| 1164599791 | Steven D. Peterson | Dentist | 202 S Gammon Rd, Ste. 150, Madison, WI 53717-1400 | 2006-11-29 |
| 1760559025 | Kenneth Noel Reed Jr. | Dentist | 451 Pebble Creek Drive, Madison, MS 39110 | 2006-11-29 |
| 1518030196 | Jeffrey Joseph Phillips | Dentist | 5605 Odana Rd, Madison, WI 53719-1207 | 2006-11-15 |
| 1902919012 | James Edwin Hatcher | Dentist | 581 Hughes Rd, Madison, AL 35758 | 2006-08-16 |
| 1821008756 | James E Paschal Jr. | Dentist | 153 W Washington St, Madison, GA 30650-1218 | 2006-08-09 |
| Find all providers in MADISON | ||||
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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.