Provider Demographics
NPI:1639608029
Name:FORBANG, ATANGA CORNELIUS
Entity Type:Individual
Prefix:
First Name:ATANGA
Middle Name:CORNELIUS
Last Name:FORBANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1608
Mailing Address - Country:US
Mailing Address - Phone:202-291-6973
Mailing Address - Fax:202-291-7018
Practice Address - Street 1:7506 GEORGIA AVENUE, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-291-6973
Practice Address - Fax:202-291-7018
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12695374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide