Individual
BANSARI MODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7165 COLFAX AVE, CUMMING, GA 30040-3027
(678) 990-3362
(678) 341-9212
Mailing address
7165 COLFAX AVE, CUMMING, GA 30040-3027
(678) 990-3362
(678) 341-9212
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
105500
GA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/25/2022
Last updated
04/15/2026
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