Tiffany Lee Boulanger, AGACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

236517 Issued in GA

Practice address

400 Tower Rd NE Ste 200
Marietta, GA 30060-9412

Phone

(770) 422-1372

NPI assigned

Jul 13, 2017

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, MA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
• Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042

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 and National Provider Directory roles.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group NPD
• Pruitthealth Physicians Services, LLC

  • Internal Medicine Physician
  • Norcross, GA
  • NPI 1043676299
  Medicare reassignment NPD
• Renew Wound Care of Georgia LLC

  • Internal Medicine Physician
  • Columbus, GA
  • NPI 1245907971
  Medicare reassignment NPD
• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573
  Medicare reassignment NPD
• Old Mission Wound Care Georgia LLC

  • Specialist
  • Traverse City, MI
  • NPI 1841030343

  GA

  Medicare reassignment NPD
• Regional Healthcare Group LLC

  • Acute Care Nurse Practitioner
  • Mount Juliet, TN
  • NPI 1407587363

  GA

  Medicare reassignment NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD
• Leewood Medical PC

  • Emergency Medicine Physician
  • Savannah, GA
  • NPI 1023416674
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Guardian Biologics LLC

  • Specialist
  • Mount Juliet, TN
  • NPI 1033890876
  NPD
• Savannah Diagnostic Assoc PC

  • Specialist
  • Savannah, GA
  • NPI 1548267438
  NPD (past)

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

• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation
• Paulding Medical Center, Inc.

  • General Acute Care Hospital
  • Hiram, GA
  • NPI 1457329435
  Care Compare affiliation

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1700308509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 ABERCORN STREET",
            "address_2": "STE 704 BOX 104",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062454",
            "telephone_number": "912-232-9700",
            "fax_number": "912-748-0270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 TOWER RD NE STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300609412",
            "telephone_number": "770-422-1372"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12345 Mercy Blvd",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314193436",
            "country_code": "US",
            "telephone_number": "912-927-3046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULANGER",
        "first_name": "TIFFANY",
        "middle_name": "LEE",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-13",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "236517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabrina Jackson Botts, MMSC., PA-C
• Bouba Logistic LLC
• Scott Emmanuel Boucan
• Anna Swanson Bouchard, AGACNP-BC
• Lynette Boudreau, D.C.
• Miriam Boulay, CRNA
• Karen E Boullain, RN
• Amanda Boulos
• Bounce, LLC
• Boundless Behavioral LLC

• Acute Care Nurse Practitioner in Marietta, GA
• Providers in Marietta, 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 Mar 28, 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.