DR. JACKSON L GATES M.D.
NPI 1962418400
General Practice in Conyers, GA
About Dr. Jackson L Gates M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JACKSON L GATES M.D. (NPI 1962418400) is an individual general practice provider in Conyers, Georgia, licensed in Georgia (038767) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Jackson L Gates M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jackson Gates reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Conyers, GA 30012
- Reassigned Medicare billing, Georgia enrollment
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 Jackson Gates's NPI number?
The NPI number for Jackson Gates is 1962418400. It was assigned to this individual provider in the NPPES registry on August 1, 2006.
Where is Jackson Gates located?
Jackson Gates practices at 1880 Lancaster Drive, Conyers, GA 30013. The listed phone number is (678) 591-6509.
What is Jackson Gates's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Jackson Gates enrolled in Medicare?
Yes. Jackson Gates is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jackson Gates's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jackson Gates reassigns Medicare benefits to Prime Care & Pathology Inc (Conyers, GA). 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 Jackson Gates's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jackson Gates was last updated on August 10, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years 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.
# Dr. Jackson L Gates, M.D. · NPI 1962418400
General Practice physician in Conyers, Georgia. Individual provider, active in the CMS NPPES registry since August 1, 2006.
## Identity
- **NPI:** 1962418400 (Entity type: Individual)
- **Enumerated:** August 1, 2006
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **State license:** 038767 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1880 LANCASTER DRIVE, Conyers, GA 30013-6433
- **Phone:** (678) 591-6509
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Prime Care & Pathology Inc (NPI 1144977802, Conyers, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 10, 2010
- **Other identifiers:** Medicare UPIN G98376
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Source: [NPI Profile](https://npiprofile.com/npi/1962418400) · Data from the CMS NPPES public registry.