Healthcare Provider Details

I. General information

NPI: 1356843528
Provider Name (Legal Business Name): TENISHA L. MEKO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 SIXES RD STE 102
CANTON GA
30114-9120
US

IV. Provider business mailing address

3422 SIXES RD STE 102
CANTON GA
30114-9120
US

V. Phone/Fax

Practice location:
  • Phone: 943-202-7670
  • Fax: 470-986-7143
Mailing address:
  • Phone: 943-202-7670
  • Fax: 470-986-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number241316
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: