Phyllis A. Tettey-Enyo, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN174444 Issued in GA

Practice address

125 King Ave Ste 200
Athens, GA 30606-6710

Phone

(706) 369-4478

Fax

(706) 353-6639

NPI assigned

Apr 14, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: penyo@landmarkhealth-direct.org
• Direct secure messaging: phyllis.tetteyenyonpc.p1@direct.gacancer.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northside Imaging LLC

  • Diagnostic Radiology Physician
  • Warner Robins, GA
  • NPI 1316394976
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1295189363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411071",
            "telephone_number": "678-288-9555",
            "fax_number": "678-288-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 KING AVE STE 200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066710",
            "telephone_number": "706-369-4478",
            "fax_number": "706-353-6639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "844 Tibwin Pl",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300452384",
            "country_code": "US",
            "telephone_number": "404-698-4905",
            "fax_number": "404-698-4905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Peachtree Industrial Blvd",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300246989",
            "country_code": "US",
            "telephone_number": "770-831-3857",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "395 Oyster Point Blvd",
            "address_purpose": "LOCATION",
            "city": "South San Francisco",
            "state": "CA",
            "postal_code": "940801928",
            "country_code": "US",
            "telephone_number": "770-331-5030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TETTEY-ENYO",
        "first_name": "PHYLLIS",
        "middle_name": "A.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-14",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN174444",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN174444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "phyllis.tetteyenyonpc.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "125 King Ave Ste 200",
            "city": "Athens",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306066710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daniel W. Tench, M.D.
• Ivey Reeves Tenny, BCBA
• Katie Terrell
• David Alejandro Terrero Rodriguez, MD, PHD
• Ronald Lynn Terry, M.D.
• Elizabeth Thacker, LPC
• Karan Thakkar
• Chandler Gerald Thames, OD
• Victor K Thao
• Ashwin Thatti

• Nurse Practitioner in Athens, GA
• Providers in Athens, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.