Individual
DR. MODESTA MAKEH TAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1175 CASCADE PKWY SW, KAISER PERMANENTE CASCADE MEMORIAL CENTER, ATLANTA, GA 30311-3090
(404) 505-4006
(404) 691-2382
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 504-5678
(404) 691-2382
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
073157
GA
207Q00000X
Family Medicine Physician
246485
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02957371
—
NY
Enumeration date
07/14/2005
Last updated
01/10/2022
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