Tina Chinwenwa Ezeh

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

RN259954 Issued in GA

Practice address

5945 Azalea Ridge Dr
Douglasville, GA 30135-5590

Phone

(770) 882-8673

NPI assigned

Jan 27, 2023

Last updated

Aug 26, 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

Electronic endpoints 1

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.tinaezeh@124220.advancedmd-direct.com

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.

• Diverse Dreams LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Douglasville, GA
  • NPI 1801788096
  Medicare reassignment NPD Authorized official
• Personal Recovery Network LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869
  Medicare reassignment Care Compare group NPD
• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  GA

  Medicare reassignment NPD
• Concordia Healthcare Services Inc

  • Home Health Agency
  • Douglasville, GA
  • NPI 1326644097
  NPD

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1740996222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6296",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301540022",
            "telephone_number": "770-882-8673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5945 AZALEA RIDGE DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355590",
            "telephone_number": "770-882-8673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZEH",
        "first_name": "TINA",
        "middle_name": "CHINWENWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-27",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN259954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Laptop",
            "affiliation": "N",
            "address_1": "5945 Azalea Ridge Dr",
            "city": "Douglasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301355590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eve Evens
• Evergreen Behavioral Management of Georgia, Inc.
• Everlasting Life Senior Care (Everlasting Life)
• Excel Allied Health Services LLC
• Excel Allied Health Services LLC
• Martine Fabien
• Oyindamola Fagbore
• Fairburn Road Chiropractic Clinic, Inc.
• Family Advocates of Ga, Inc
• Family and Forensic Intervention Counseling Services

• Psychiatric/Mental Health Clinical Nurse Specialist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.