JACQUIECE LIDDELL AGACNP
NPI 1467988543
Nurse Practitioner - Acute Care in Ellenwood, GA
About Jacquiece Liddell Agacnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUIECE LIDDELL AGACNP (NPI 1467988543) is an individual acute care provider in Ellenwood, Georgia, licensed in Georgia (RN206975) and active in the NPI registry since May 2017. She is enrolled in Medicare PECOS, is affiliated with Northside Hospital, and is a graduate of Other (2015).
NPPES Registry Identity
Specialties & Licenses
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
Jacquiece Liddell Agacnp 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
3Medicare enrollment records show Jacquiece Liddell reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Atlanta, GA 30322
- Reassigned Medicare billing, Georgia enrollment
- 4,840 clinicians in this Medicare group
Atlanta, GA 30331
- Reassigned Medicare billing, Georgia enrollment
- 3,885 clinicians in this Medicare group
Atlanta, GA 30342
- Reassigned Medicare billing, Georgia enrollment
- 466 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.
Northside Hospital
Acute Care Hospitals · Atlanta, GAPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30294 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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 Jacquiece Liddell's NPI number?
The NPI number for Jacquiece Liddell is 1467988543. It was assigned to this individual provider in the NPPES registry on May 10, 2017.
Where is Jacquiece Liddell located?
Jacquiece Liddell practices at 4357 Boxwood Trl, Ellenwood, GA 30294. The listed phone number is (678) 517-7897.
What is Jacquiece Liddell's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.
Is Jacquiece Liddell enrolled in Medicare?
Yes. Jacquiece Liddell 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 Jacquiece Liddell's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacquiece Liddell reassigns Medicare benefits to 3 organizations: The Emory Clinic Inc (Atlanta, GA), Wellstar Medical Group, LLC (Atlanta, GA) and Northside Primary Care Professional Services,llc (Atlanta, 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 Jacquiece Liddell's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Jacquiece Liddell affiliated with any hospitals?
According to CMS data, Jacquiece Liddell is affiliated with Northside Hospital.
When was this NPI record last updated?
The NPPES record for Jacquiece Liddell was last updated on November 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Jacquiece Liddell, AGACNP · NPI 1467988543
Acute Care physician in Ellenwood, Georgia. Individual provider, active in the CMS NPPES registry since May 10, 2017.
## Identity
- **NPI:** 1467988543 (Entity type: Individual)
- **Enumerated:** May 10, 2017
- **Primary specialty:** Nurse Practitioner - Acute Care · taxonomy 363LA2100X
- **State license:** RN206975 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4357 BOXWOOD TRL, Ellenwood, GA 30294-6518
- **Phone:** (678) 517-7897
## 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:** 3 organizations under Medicare reassignment (form CMS-855R): The Emory Clinic Inc (NPI 1396798229, Atlanta, GA); Wellstar Medical Group, LLC (NPI 1205267192, Atlanta, GA); Northside Primary Care Professional Services,llc (NPI 1922397553, Atlanta, GA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2015
## Record status
- **NPPES last updated:** November 8, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1467988543) · Data from the CMS NPPES public registry.