Provider Demographics
NPI:1306391198
Name:ETENGENENG, ENYANG (PMHNP)
Entity type:Individual
Prefix:
First Name:ENYANG
Middle Name:
Last Name:ETENGENENG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 S MILLEDGE AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1292
Mailing Address - Country:US
Mailing Address - Phone:706-498-9560
Mailing Address - Fax:706-498-9568
Practice Address - Street 1:745 S MILLEDGE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1292
Practice Address - Country:US
Practice Address - Phone:706-498-9560
Practice Address - Fax:706-498-9568
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214571163W00000X
GAAPRN-NP214571363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse