Provider Demographics
NPI:1578759619
Name:COWDEN, CONSTANCE COLEMAN (APRN- ADULT NURS)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:COLEMAN
Last Name:COWDEN
Suffix:
Gender:F
Credentials:APRN- ADULT NURS
Other - Prefix:
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Mailing Address - Street 1:5775-B GLENRIDEGE DR.
Mailing Address - Street 2:145
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-659-5909
Mailing Address - Fax:770-399-9449
Practice Address - Street 1:2121 FOUNTAIN DR.
Practice Address - Street 2:SUITE F
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:404-659-5909
Practice Address - Fax:770-399-9449
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2010-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN042124363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00899775CMedicaid
GAP28332Medicare UPIN