Jacquiece Liddell, AGACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN206975 Issued in GA

Practice address

4357 Boxwood TRL
Ellenwood, GA 30294-6518

Phone

(678) 517-7897

NPI assigned

May 10, 2017

Last updated

Nov 8, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Primary Care Professional Services,LLCGroup PAC ID 9638343924, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score

94.51 of 100Reported as apm

Quality

80.61

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  Medicare reassignment Care Compare group NPD
• The Emory Clinic Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1396798229
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Northside Primary Care Professional Services, LLC

  • Urgent Care Clinic/Center
  • Dawsonville, GA
  • NPI 1215369715
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Medical Group, LLC

  dba WellStar Family Medicine at BridgeMill

  • Family Medicine Physician
  • Canton, GA
  • NPI 1346593316
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  dba Northside Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

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

{
    "created_epoch": "1494374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762560000000",
    "number": "1467988543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4357 BOXWOOD TRAIL",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "30294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4357 BOXWOOD TRL",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302946518",
            "telephone_number": "678-517-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDELL",
        "first_name": "JACQUIECE",
        "credential": "AGACNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-10",
        "last_updated": "2025-11-08",
        "certification_date": "2025-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN206975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claudea Antonette Lewis-Comrie
• Dornel J Lewis, NURSE PRACTITIONER
• Jacqueline Lewis, NP
• Kevin J Lewis, RT
• Mani Lewis
• Life Intervention Network Center
• Life Wellness Group of Atlanta
• Lillian Davenport Parker
• Tracy Lin, MS, OTR/L
• Wilbur T. Little

• Acute Care Nurse Practitioner in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Acute Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.