Healthcare Provider Details

I. General information

NPI: 1306391198
Provider Name (Legal Business Name): ENYANG ETENGENENG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S MILLEDGE AVE STE 1A
ATHENS GA
30605-1292
US

IV. Provider business mailing address

745 S MILLEDGE AVE STE 1A
ATHENS GA
30605-1292
US

V. Phone/Fax

Practice location:
  • Phone: 706-498-9560
  • Fax: 706-498-9568
Mailing address:
  • Phone: 706-498-9560
  • Fax: 706-498-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP214571
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN214571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: