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SAMANTHA LIVERPOOL-JACKSON
NPI 1497419683
Counselor - Mental Health in Conyers, GA

Active since October 25, 2021PECOS Enrolled
1387 MOURNING DOVE DR SW, CONYERS, GA 30094(404) 593-0516 Get Directions Write a Review

NPPES record last updated: April 14, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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.

NPPES Registry Identity

NPI1497419683
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSAMANTHA LIVERPOOL-JACKSON
Location Address1387 MOURNING DOVE DR SWConyers, GA 30094-5761
Mailing Address2215 Exchange Pl SeConyers, GA 30013-6723 · (770) 679-0586
Phone(404) 593-0516
Sole ProprietorNo
Enumeration DateOctober 25, 2021
Last NPPES UpdateApril 14, 2026
NPPES CertifiedApril 14, 2026
✔ NPI 1497419683 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in GA · 010154
1387 MOURNING DOVE DR SW, Conyers, GA 30094
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Liverpool-jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

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 3 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.