NPI age
9 years
Enumerated 2017-05-10
● Active
Type 1 · Individual
Jacquiece Liddell, AGACNP
Liddell is 1 of 2 nurse practitioner providers in Ellenwood and 1 of 950 in Georgia.
Primary specialty
Nurse Practitioner
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2025-11-08
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 950 active nurse practitioner providers in Georgia.
NPI age
9 years
↑ 3 yr above median (6 yr)
State licenses
1 state
8% of peers hold multiple states
Subspecialties
0
36% of peers hold subspecialties
NPI lifetime · 2017 → 2026
2017-05Enumerated in NPPES
2017
2026
Where they practice
Practice location
4357 Boxwood Trl
Ellenwood, GA 302946518
Mailing address
4357 Boxwood Trail
Ellenwood, GA 30294
Specialties
-
Nurse Practitioner PrimaryDefinition to come...
Practice context
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
Provyx · Custom healthcare lists
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Request a quote →How to verify this provider
- 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.