Individual
DR. TINA BETTY EZEOLISAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-BC
Contact information
Practice address
3355 MCDANIEL RD, APT 17401, DULUTH, GA 30096-8613
(678) 704-3593
Mailing address
1814 CLAIRMONT RD, DECATUR, GA 30033-3405
(404) 636-1457
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 217223
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
05031
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
C-APN.0002066-C-NP
CO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN217223
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN2345725
MA
Other
Enumeration date
07/15/2016
Last updated
12/02/2022
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