MRS. SOPHIA EVETTE JACKSON NP NPI 1093879769

NPI Information

  • NPI: 1093879769
  • Provider Name: MRS. SOPHIA EVETTE JACKSON, NP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1950 BUFORD HWY
    CVS CAREMARK MINUTE CLINIC
    BUFORD, GA
    ZIP 30518
  • Phone: (770) 945-7286

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NPI Details

MRS. Sophia Evette Jackson, NP is a family nurse practitioner in Buford, GA with 28 years of experience. MRS. Sophia Evette Jackson, NP NPI is 1093879769. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1950 BUFORD HWY
CVS CAREMARK MINUTE CLINIC
BUFORD, GA
ZIP 30518-673
Phone: (770) 945-7286

The NPI 1093879769 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)

The enumeration date for this NPI number is 12/20/2006 and was last updated on 9/16/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyRN117221GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100792426CMEDICAIDGEORGIA
2S56481MEDICARE UPINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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