Diverse Dreams LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

DIVERSE DREAMS LLC

Practice address

2959 Chapel Hill Rd Ste D1185
Douglasville, GA 30135-1785

Phone

(706) 883-5885

NPI assigned

Jul 21, 2025

Organization subpart

No

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

Authorized official

Name

Tina EzehNPI 1740996222

Title

Ceo

Phone

(706) 883-5885

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tina Chinwenwa Ezeh

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Douglasville, GA
  • NPI 1740996222
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1801788096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5945 AZALEA RIDGE DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2959 CHAPEL HILL RD STE D1185",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351785",
            "telephone_number": "706-883-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSE DREAMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "EZEH",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-883-5885"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.