Basic Information
| Provider Information | |||||||||
| NPI: | 1578759619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COWDEN | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | COLEMAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | A.P.R.N.- ADULT NURS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5775-B GLENRIDEGE DR. | ||||||||
| Address2: | 145 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046595909 | ||||||||
| FaxNumber: | 7703999449 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 FOUNTAIN DR. | ||||||||
| Address2: | SUITE F | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046595909 | ||||||||
| FaxNumber: | 7703999449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN042124 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 00899775C | 05 | GA | MEDICAID |