Provider Demographics
NPI:1316555642
Name:TAKANG, CONSTANCE OFUNDEM (NP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:OFUNDEM
Last Name:TAKANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MINUTECLINIC #7214
Mailing Address - Street 2:2305 HIGHWAY 34 E
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:678-423-1043
Mailing Address - Fax:
Practice Address - Street 1:MINUTECLINIC #7214
Practice Address - Street 2:2305 HIGHWAY 34 E
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:678-423-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF03200096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily