Candace Marvenia Tillman, RNC, MS, WHNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN142932 Issued in GA

Practice address

3230 Old Church CV NE
Conyers, GA 30012-2647

Phone

(678) 221-8855

NPI assigned

Feb 2, 2012

Last updated

Sep 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitality Ageless Center LLCGroup PAC ID 6800135872, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, 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.

• Vitality Ageless Center LLC

  • Multi-Specialty Clinic/Center
  • Suwanee, GA
  • NPI 1730657271
  Medicare reassignment Care Compare group NPD
• Vpa PC

  dba Harmonycares Medical Group

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1164149365
  Medicare reassignment NPD
• Vpa PC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD
• The Center for Black Womens Wellness CBWW Inc

  • Gynecology Physician
  • Atlanta, GA
  • NPI 1669813580
  NPD (past)

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725753600000",
    "number": "1871865113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3230 OLD CHURCH CV NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300122647",
            "telephone_number": "678-221-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 OLD CHURCH CV NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300122647",
            "telephone_number": "678-221-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "CANDACE",
        "middle_name": "MARVENIA",
        "name_prefix": "Ms.",
        "credential": "RNC, MS, WHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN142932",
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "GA",
            "license": "RN142932",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF GEORGIA",
            "identifier": "RN142932",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Akeba Deqwan Thompson, NP
• Tristen Quiera Thompson, BS, MS
• Thrive With Care, LLC
• Through His Hands, Inc.
• Darlene Lois Tiggs, LCSW
• Lorraine Tillman, LMSW
• Stautcia Tillman, MS, LPC, NCC
• Tma Counseling and Coaching Services, LLC
• To the Root Counseling & Coaching
• Mark Tomberlin Jr., LPC

• Adult Health Nurse Practitioner in Conyers, GA
• Providers in Conyers, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2024; 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.