Jacquiece Liddell, AGACNP
Jacquiece Liddell, AGACNP is a Nurse Practitioner in Ellenwood, Georgia. Qualified in 2015, 11 years ago. Practices with Northside Primary Care Professional Services, LLC, a 311-clinician group and accepts Medicare assignment. Licensed in Georgia.
- Years since qualifying
- 11
- Licensed in
- GA
- In the registry since
- 2017
Practice location Address checks out
4357 Boxwood TrlEllenwood, GA 30294-6518
Phone: (678) 517-7897
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Acute Care Nurse Practitioner (primary) | Taxonomy 363LA2100X · Licence RN206975 (GA) |
|---|
Record details
| NPI number | 1467988543 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Credentials | AGACNP |
| Sole proprietor | Yes |
| NPI enumerated | May 10, 2017 |
| Last updated in NPPES | November 8, 2025 |
| Certification date | November 8, 2025 |
Medicare enrollment
| Medicare specialty | NURSE PRACTITIONER |
|---|---|
| Medical school | OTHER |
| Graduated | 2015 (11 years in practice) |
| Group practice | Northside Primary Care Professional Services,Llc — 311 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
Other providers in Ellenwood
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Gwendolyn Elaine Montgomery, NURSEPRACTITIONER
3962 Busby Mill Ct, Ellenwood, GA 30294-2052 · (404) 314-7295