DR. JACKSON L GATES (NPI# 1962418400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962418400 |
| Entity Type | Individual |
| Full Name | DR. JACKSON L GATES |
| Credential | M.D. |
| Practice Address |
1880 Lancaster Drive Conyers GA 30013-6433 |
| Mailing Address |
777 Cleveland Ave Sw Suite 100 Atlanta GA 30315-7129 |
| Practice Telephone | 6785916509 |
| Mailing Telephone | 4047630093 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2010-08-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
038767 | GA | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 038767 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1880 LANCASTER DRIVE |
| City | CONYERS |
| State | GA |
| Zip Code | 30013-6433 |
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|---|---|---|---|---|
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| 1144854753 | Atl Optical LLC | Optometrist | 1285 Ga 138, Conyers, GA 30013 | 2020-02-24 |
| 1386201820 | Achundris P Taylor | Social Worker | Harvest Grove Lane, Conyers, GA 30013 | 2019-05-21 |
| 1588153381 | Curbside Medical Transporters | Ambulance | 2404 Brynlyn Woods Dr Ne, Conyers, GA 30013 | 2018-05-07 |
| 1184124877 | Nursing Companion, LLC | Homemaker | 1064 Duke Dr, Conyers, GA 30013 | 2018-02-19 |
| 1588163638 | Atlanta Plus Urgent Care | Clinic/Center | 2121 Salem Rd. Se, Conyers, GA 30013 | 2018-02-05 |
| 1043735244 | Niki Tanyell Davis | Licensed Practical Nurse | 1403 Windy Hill Court, Conyers, GA 30013 | 2017-08-08 |
| 1063941490 | Comprehensive Health and Rehab LLC | Clinic/Center | 2500 Riverton Drive, Conyers, GA 30013 | 2017-06-08 |
| 1306373188 | Graceol Corporation | Family Medicine | 1035 Honey Creek Rd, Conyers, GA 30013 | 2017-05-11 |
| 1881149268 | Jsa Dental Associates Conyers PC | Dentist | 1151 Nor Tec Dr, Suite B, Conyers, GA 30013 | 2016-08-16 |
| Find all providers in zip 30013 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
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| 1649210006 | Sollage Pain Solutions of Georgia | General Practice | 1701 Ellington Rd Se, Suite B, Conyers, GA 30013-2192 | 2006-06-07 |
| 1285814491 | Darryl S Gross Md PC | General Practice | 2280 Salem Rd Se, Suite 102, Conyers, GA 30013-2003 | 2007-11-06 |
| 1407941131 | Jack Lee Sorg | General Practice | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1306844675 | Mary Jane B Kassam | General Practice | 2020 Honey Creek Pkwy Se, Conyers, GA 30013-2974 | 2005-07-12 |
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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.