# MODERN INTERNAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982095360
- **Authorized official:** DEANDRE GREEN (CEO)
- **Authorized official phone:** (404) 368-8655

## Contact information

- **Practice address:** 2457 MARTIN LUTHER KING JR DR SW, SUITE A, ATLANTA, GA 30311-1712
- **Practice address phone:** (404) 368-8655
- **Mailing address:** 2457 MARTIN LUTHER KING JR DR SW, SUITE A, ATLANTA, GA 30311-1712
- **Mailing address phone:** (404) 368-8655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/06/2015
- **Last updated:** 02/06/2015