Dr Tina Betty Ezeolisah, DNP, PMHNP-BC - Medicare Nurse Practitioner in Duluth, GA

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Dr Tina Betty Ezeolisah, DNP, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Duluth, Georgia. Her current practice location is 3355 Mcdaniel Rd, Apt 17401, Duluth, Georgia. You can reach out to her office (for appointments etc.) via phone at (678) 704-3593.

Dr Tina Betty Ezeolisah is licensed to practice in Georgia (license number RN217223) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1306299268.

Contact Information

Dr Tina Betty Ezeolisah, DNP, PMHNP-BC
3355 Mcdaniel Rd, Apt 17401,
Duluth, GA 30096-8613
(678) 704-3593
Not Available

Map and Direction




Provider's Profile

Full NameDr Tina Betty Ezeolisah
GenderFemale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location3355 Mcdaniel Rd, Duluth, Georgia
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1306299268
  • Provider Enumeration Date: 07/15/2016
  • Last Update Date: 12/02/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 1850667957
  • Enrollment ID: I20171017002720

Medical Identifiers

Medical identifiers for Dr Tina Betty Ezeolisah such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1306299268NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LP0808XNurse Practitioner - Psychiatric/mental Health RN2345725 (Massachusetts)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health C-APN.0002066-C-NP (Colorado)Secondary
163W00000XRegistered Nurse RN 217223 (Georgia)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health 05031 (Rhode Island)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health RN217223 (Georgia)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Tina Betty Ezeolisah allows following entities to bill medicare on her behalf.
Entity NameHighland Rivers Community Service Board
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1447256243
PECOS PAC ID: 9032000245
Enrollment ID: O20040324001204
Entity NamePersonal Recovery Network Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1881990869
PECOS PAC ID: 5092611384
Enrollment ID: O20120110000096

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Tina Betty Ezeolisah is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Tina Betty Ezeolisah, DNP, PMHNP-BC
1814 Clairmont Rd,
Decatur, GA 30033-3405

Ph: (404) 636-1457		Dr Tina Betty Ezeolisah, DNP, PMHNP-BC
3355 Mcdaniel Rd, Apt 17401,
Duluth, GA 30096-8613

Ph: (678) 704-3593

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

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