MEDICARE: TENISHA L. MEKO NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	241316	GA
2	363LF0000X	Family Nurse Practitioner	241316	GA

General Provider Information

NPI Number	:	1356843528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENISHA L. MEKO NP-C

Provider Business Mailing Address
First Line	:	3422 SIXES RD STE 102
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9120
Country	:	US
Telephone Number	:	943-202-7670
Fax Number	:	470-986-7143

Provider Business Practice Location Address
First Line	:	3422 SIXES RD STE 102
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9120
Country	:	US
Telephone Number	:	943-202-7670
Fax Number	:	470-986-7143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	10/09/2025

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