Tina Chinwenwa Ezeh, is a medicare enrolled "Clinical Nurse Specialist - Psychiatric/mental Health" in Douglasville, Georgia. She graduated from nursing school in 2022 and has 4 years of diverse experience with area of expertise as Nurse Practitioner. Her current practice location is
5945 Azalea Ridge Dr, Douglasville, Georgia. You can reach out to her office (for appointments etc.) via phone at
(770) 882-8673.
Tina Chinwenwa Ezeh is licensed to practice in Georgia (license number RN259954) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1740996222.
Provider's Profile
| Full Name | Tina Chinwenwa Ezeh |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 4 Years |
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| Location | 5945 Azalea Ridge Dr, Douglasville, Georgia |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Tina Chinwenwa Ezeh graduated from nursing school in 2022
NPI Data:
- NPI Number: 1740996222
- Provider Enumeration Date: 01/27/2023
- Last Update Date: 08/26/2025
Medicare PECOS Information:
- PECOS PAC ID: 1456711423
- Enrollment ID: I20250610004245
Medical Identifiers
Medical identifiers for Tina Chinwenwa Ezeh such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1740996222 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 364SP0808X | Clinical Nurse Specialist - Psychiatric/mental Health | RN259954 (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. Tina Chinwenwa Ezeh allows following entities to bill medicare on her behalf.
| Entity Name | Mental Health Specialty Group Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1801472634
PECOS PAC ID: 8921466228
Enrollment ID: O20230619001228 |
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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. Tina Chinwenwa Ezeh 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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Tina Chinwenwa Ezeh,
Po Box 6296,
Douglasville, GA 30154-0022
Ph: (770) 882-8673 | Tina Chinwenwa Ezeh,
5945 Azalea Ridge Dr,
Douglasville, GA 30135-5590
Ph: (770) 882-8673 |
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