=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578759619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSTANCE COLEMAN COWDEN A.P.R.N.- ADULT NURS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 FOUNTAIN DR. SUITE F
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-659-5909
-----------------------------------------------------
Fax | 770-399-9449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5775-B GLENRIDEGE DR. 145
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-659-5909
-----------------------------------------------------
Fax | 770-399-9449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN042124
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------