MRS. CARROLL DAVIS JACKSON (APRN) – Family Nurse Practitioner, NPI 1982111704
Family Nurse Practitioner
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
9,652 NURSE PRACTITIONER in GA
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Provider Addresses for MRS. CARROLL DAVIS JACKSON (APRN)
130, Moore Street, Omega, Tift County, Georgia, 31775, United States
OMEGA, GA 317753075
Phone: (229) 528-6500
Type: Location
3321, North Valdosta Road, Five Points, Valdosta, Lowndes County, Georgia, 31602, United States
VALDOSTA, GA 316021685
Phone: (229) 242-9310
Type: Mailing
172 MJ TAYLOR RD
ADEL, GA 316203497
Phone: (229) 896-8500
Type: Location
907 18TH ST E STE 400
TIFTON, GA 317943684
Phone: (229) 353-3422
Fax: (229) 353-6060
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 14 Open Payments records for all available years, with a total value of $265.
Total Amount is formed as General ($265) + Research ($0) + Ownership ($0) = $265.
Last reported payment date: 2024-11-12 • Largest payer in this snapshot: Dexcom, Inc. ($87).
Total Amount
$265
General + Research + Ownership
Payments
14
Total payment records
General Amount
$265
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-12
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-03-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200325002168 | I | Nurse Practitioner | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 31775)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | GA | |
| Nurse Practitioner | GA | |
| - | GA | |
| Nurse Practitioner | GA | |
| - | GA | |
| - | GA | |
| Nurse Practitioner | GA | |
| Family Practice, Emergency Medicine | GA | |
| Internal Medicine, Critical Care (Intensivists), Pulmonary Disease, Pulmonary Disease | MD | |
| - | GA |
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