Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miss. Kenosha Latrice Tillman, NURSEPRACTITIONER

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1275886103

Miss. Kenosha Latrice Tillman, NURSEPRACTITIONER is a Nurse Practitioner in Fairburn, Georgia. Qualified in 2022, 4 years ago. Practices with Piedmont Hospitalist Physicians LLC, a 497-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
4
Licensed in
GA
In the registry since
2012

Practice location Address checks out

5220 Rosewood Pl
Fairburn, GA 30213-5113
Phone: (901) 277-7086
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1255 Highway 54 W, Fayetteville, GA 30214-4526 — (478) 464-8134
  • 101 Webb Avenue, Bruce, MS 38915-0701 — (662) 414-9212

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence GAA-NP000960 (GA)

Record details

NPI number1275886103
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedOctober 16, 2012
Last updated in NPPESNovember 7, 2024
Certification dateNovember 7, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Piedmont Hospitalist Physicians Llc — 497 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Fairburn