Provider Demographics
NPI:1497317937
Name:BANG, JOAN CATE (NP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CATE
Last Name:BANG
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-0606
Mailing Address - Country:US
Mailing Address - Phone:706-639-9055
Mailing Address - Fax:706-639-9057
Practice Address - Street 1:3824 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-3967
Practice Address - Country:US
Practice Address - Phone:706-639-9055
Practice Address - Fax:706-639-9057
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily