DR. TINA BETTY EZEOLISAH (DNP, PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1306299268
Psychiatric/Mental Health Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. TINA BETTY EZEOLISAH (DNP, PMHNP-BC)
940 Concord Rd SE
Smyrna, GA 300804204
Phone: (404) 636-1457
Fax: (404) 636-7449
Type: Location
3355 MCDANIEL RD
APT 17401
DULUTH, GA 300968613
Phone: (678) 704-3593
Type: Mailing
1814 Clairmont Rd
Decatur, GA 300333405
Phone: (404) 636-1457
Fax: (404) 636-7449
Type: Location
1814 CLAIRMONT RD
DECATUR, GA 300333405
Phone: (404) 636-1457
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $113.
Total Amount is formed as General ($113) + Research ($0) + Ownership ($0) = $113.
Last reported payment date: 2024-10-09 • Largest payer in this snapshot: ABBVIE INC. ($113).
Total Amount
$113
General + Research + Ownership
Payments
1
Total payment records
General Amount
$113
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-09
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $113 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-10-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20171017002720 | I | Nurse Practitioner | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30080)
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