MISS KENOSHA LATRICE TILLMAN NURSE PRACTITIONER
NPI 1275886103
Nurse Practitioner - Psychiatric/Mental Health in Fairburn, GA
About Miss Kenosha Latrice Tillman Nurse Practitioner NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MISS KENOSHA LATRICE TILLMAN NURSE PRACTITIONER (NPI 1275886103) is an individual psychiatric/mental health provider in Fairburn, Georgia, licensed in Georgia (GAA-NP000960) and active in the NPI registry since October 2012. She is enrolled in Medicare PECOS, is affiliated with Piedmont Henry Hospital, and maintains 2 additional practice locations.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Miss Kenosha Latrice Tillman Nurse Practitioner is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
4Medicare enrollment records show Kenosha Tillman reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Atlanta, GA 30309
- Reassigned Medicare billing, Georgia enrollment
- 410 clinicians in this Medicare group
Stockbridge, GA 30281
- Reassigned Medicare billing, Georgia enrollment
- 792 clinicians in this Medicare group
Duluth, GA 30097
- Reassigned Medicare billing, Georgia enrollment
- 17 clinicians in this Medicare group
Columbus, GA 31901
- Reassigned Medicare billing, Georgia enrollment
- 391 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Piedmont Henry Hospital
Acute Care Hospitals · Stockbridge, GAPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30213 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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 Kenosha Tillman's NPI number?
The NPI number for Kenosha Tillman is 1275886103. It was assigned to this individual provider in the NPPES registry on October 16, 2012.
Where is Kenosha Tillman located?
Kenosha Tillman practices at 5220 Rosewood Pl, Fairburn, GA 30213. The listed phone number is (901) 277-7086.
What is Kenosha Tillman's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Kenosha Tillman enrolled in Medicare?
Yes. Kenosha Tillman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kenosha Tillman's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kenosha Tillman reassigns Medicare benefits to 4 organizations: Piedmont Athens Hospitalist Physicians LLC (Atlanta, GA), Piedmont Hospitalist Physicians LLC (Stockbridge, GA), Inner Community Health (Duluth, GA) and Columbus Ambulatory Healthcare Services, Inc. (Columbus, GA). Each 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 Kenosha Tillman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Kenosha Tillman affiliated with any hospitals?
According to CMS data, Kenosha Tillman is affiliated with Piedmont Henry Hospital.
When was this NPI record last updated?
The NPPES record for Kenosha Tillman was last updated on November 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.
# Miss Kenosha Latrice Tillman, NURSE PRACTITIONER · NPI 1275886103
Psychiatric/Mental Health physician in Fairburn, Georgia. Individual provider, active in the CMS NPPES registry since October 16, 2012.
## Identity
- **NPI:** 1275886103 (Entity type: Individual)
- **Enumerated:** October 16, 2012
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** GAA-NP000960 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 5220 ROSEWOOD PL, Fairburn, GA 30213-5113
- **Phone:** (901) 277-7086
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 4 organizations under Medicare reassignment (form CMS-855R): Piedmont Athens Hospitalist Physicians LLC (NPI 1578079000, Atlanta, GA); Piedmont Hospitalist Physicians LLC (NPI 1548219660, Stockbridge, GA); Inner Community Health (NPI 1891398541, Duluth, GA); Columbus Ambulatory Healthcare Services, Inc. (NPI 1790733244, Columbus, GA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** November 7, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1275886103) · Data from the CMS NPPES public registry.