SAMANTHA LIVERPOOL-JACKSON
NPI 1497419683
Counselor - Mental Health in Conyers, GA
About Samantha Liverpool-jackson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMANTHA LIVERPOOL-JACKSON (NPI 1497419683) is an individual mental health provider in Conyers, Georgia, licensed in Georgia (010154) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2017).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samantha Liverpool-jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Samantha Liverpool-jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Bethesda, MD 20814
- Reassigned Medicare billing, Georgia enrollment
- 27 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samantha Liverpool-jackson's NPI number?
The NPI number for Samantha Liverpool-jackson is 1497419683. It was assigned to this individual provider in the NPPES registry on October 25, 2021.
Where is Samantha Liverpool-jackson located?
Samantha Liverpool-jackson practices at 1387 Mourning Dove Dr SW, Conyers, GA 30094. The listed phone number is (404) 593-0516.
What is Samantha Liverpool-jackson's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Samantha Liverpool-jackson enrolled in Medicare?
Yes. Samantha Liverpool-jackson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Samantha Liverpool-jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Liverpool-jackson reassigns Medicare benefits to Uplift Behavioral Health PC (Bethesda, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samantha Liverpool-jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samantha Liverpool-jackson accept?
Health plans from UnitedHealthcare list Samantha Liverpool-jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Samantha Liverpool-jackson was last updated on April 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Samantha Liverpool-Jackson · NPI 1497419683
Mental Health provider in Conyers, Georgia. Individual provider, active in the CMS NPPES registry since October 25, 2021.
## Identity
- **NPI:** 1497419683 (Entity type: Individual)
- **Enumerated:** October 25, 2021
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** 010154 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 1387 MOURNING DOVE DR SW, Conyers, GA 30094-5761
- **Phone:** (404) 593-0516
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Uplift Behavioral Health PC (NPI 1629740410, Bethesda, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2017
## Record status
- **NPPES last updated:** April 14, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1497419683) · Data from the CMS NPPES public registry.