Tiny Benita Wilson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN135948NP Issued in GA

Practice address

2890 Georgia Highway 212 SW Ste A360
Conyers, GA 30094

Phone

(770) 601-6892

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  GA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1417029133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2890 GEORGIA HIGHWAY 212 SW STE A360",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943363",
            "telephone_number": "770-601-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2890 GEORGIA HIGHWAY 212 SW STE A360",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30094",
            "telephone_number": "770-601-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TINY",
        "middle_name": "BENITA",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN135948NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabriyya Ariel Willis
• Catrina Wilson
• Erica R Wilson, MEDCCCSLP
• Hunter Callahan Wilson, M.D.
• Jamie E Wilson
• Dannia Marie Wint, NURSE PRACTITIONER
• Wise Choice Residential
• Joseph William Witherspoon Jr., LMSW
• Jennifer Gill Witmer, CNM
• William Ernest Wolf, DDS

• Family Nurse Practitioner in Conyers, GA
• Providers in Conyers, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.