NPI age
13 years
Enumerated 2012-10-16
● Active
Type 1 · Individual
MISS Kenosha Latrice Tillman, NURSE PRACTITIONER
Tillman is 1 of 7 nurse practitioner providers in Fairburn and 1 of 1622 in Georgia.
Primary specialty
Nurse Practitioner
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2024-11-07
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1622 active nurse practitioner providers in Georgia.
NPI age
13 years
↑ 9 yr above median (4 yr)
State licenses
1 state
12% of peers hold multiple states
Subspecialties
0
37% of peers hold subspecialties
NPI lifetime · 2012 → 2026
2012-10Enumerated in NPPES
2012
2026
Where they practice
Practice location
5220 Rosewood Pl
Fairburn, GA 302135113
Mailing address
5220 Rosewood Pl
Fairburn, GA 302135113
Additional practice locations
2 secondary locations on file with NPPES.
Location 2
101 Webb Avenue
Bruce, MS 389150701
Location 3
1255 Highway 54 W
Fayetteville, GA 302144526
Specialties
-
Nurse Practitioner PrimaryDefinition to come...
Practice context
Solo or small practice. No other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.