Lychannel Ticole Head, is a medicare enrolled "Specialist" in Locust Grove, Georgia. She graduated from nursing school in 2022 and has 3 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Family Medical And Urgent Care Clinic Of Mcdonough, Llc and her current practice location is
4865 Bill Gardner Pkwy, Locust Grove, Georgia. You can reach out to her office (for appointments etc.) via phone at
(770) 692-0100.
Lychannel Ticole Head is licensed to practice in Georgia (license number 1952405052) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1871163097.
Provider's Profile
| Full Name | Lychannel Ticole Head |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 3 Years |
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| Location | 4865 Bill Gardner Pkwy, Locust Grove, Georgia |
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| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Lychannel Ticole Head graduated from nursing school in 2022
NPI Data:
- NPI Number: 1871163097
- Provider Enumeration Date: 06/29/2021
- Last Update Date: 01/20/2023
Medicare PECOS Information:
- PECOS PAC ID: 8729435490
- Enrollment ID: I20231117001015
Medical Identifiers
Medical identifiers for Lychannel Ticole Head such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1871163097 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | F06211529 (Georgia) | Secondary |
| 174400000X | Specialist | 1952405052 (Georgia) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Family Medical And Urgent Care Clinic Of Mcdonough, Llc | 7113054131 | 20 |
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. Lychannel Ticole Head allows following entities to bill medicare on her behalf.
| Entity Name | Family Medical And Urgent Care Clinic Of Mcdonough, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1043440530
PECOS PAC ID: 7113054131
Enrollment ID: O20100423000172 |
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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. Lychannel Ticole Head 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 Address | Practice Location Address |
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Lychannel Ticole Head,
4865 Bill Gardner Pkwy,
Locust Grove, GA 30248-3644
Ph: (770) 692-0100 | Lychannel Ticole Head,
4865 Bill Gardner Pkwy,
Locust Grove, GA 30248-3644
Ph: (770) 692-0100 |
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