DR. TINA BETTY EZEOLISAH DNP, PMHNP-BC
NPI 1306299268
Nurse Practitioner - Psychiatric/Mental Health in Duluth, GA
About Dr. Tina Betty Ezeolisah Dnp, Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. TINA BETTY EZEOLISAH DNP, PMHNP-BC (NPI 1306299268) is an individual psychiatric/mental health provider in Duluth, Georgia, licensed in Georgia (RN217223) and active in the NPI registry since July 2016. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 2
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)
Dr. Tina Betty Ezeolisah Dnp, Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Tina Ezeolisah reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Canton, GA 30114
- Reassigned Medicare billing, Georgia enrollment
- Medicare enrollment name: Highland Rivers Community Service Board
- 142 clinicians in this Medicare group
Stockbridge, GA 30281
- Reassigned Medicare billing, Georgia enrollment
- 592 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30096 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Tina Ezeolisah's NPI number?
The NPI number for Tina Ezeolisah is 1306299268. It was assigned to this individual provider in the NPPES registry on July 15, 2016.
Where is Tina Ezeolisah located?
Tina Ezeolisah practices at 3355 Mcdaniel Rd Apt 17401, Duluth, GA 30096. The listed phone number is (678) 704-3593.
What is Tina Ezeolisah's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Tina Ezeolisah enrolled in Medicare?
Yes. Tina Ezeolisah is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Tina Ezeolisah's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tina Ezeolisah reassigns Medicare benefits to 2 organizations: Highland Rivers Csb (Canton, GA) and Personal Recovery Network LLC (Stockbridge, 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 Tina Ezeolisah's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Tina Ezeolisah accept?
Health plans from Oscar Insurance Company list Tina Ezeolisah 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 Tina Ezeolisah was last updated on December 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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. Tina Betty Ezeolisah, DNP, PMHNP-BC · NPI 1306299268
Psychiatric/Mental Health physician in Duluth, Georgia. Individual provider, active in the CMS NPPES registry since July 15, 2016.
## Identity
- **NPI:** 1306299268 (Entity type: Individual)
- **Enumerated:** July 15, 2016
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** RN217223 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 3355 MCDANIEL RD, APT 17401, Duluth, GA 30096-8613
- **Phone:** (678) 704-3593
## 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:** 2 organizations under Medicare reassignment (form CMS-855R): Highland Rivers Csb (NPI 1043373467, Canton, GA); Personal Recovery Network LLC (NPI 1881990869, Stockbridge, GA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 2, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1306299268) · Data from the CMS NPPES public registry.