Organization
MISHARI PRIMARY CARE AND AESTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANASTACIA P MODO FNP-C (OWNER)
(678) 834-3828
Entity
Organization
Contact information
Practice address
2704 HAYNESCREST DR, GRAYSON, GA 30017-4280
(678) 834-3828
Mailing address
2704 HAYNESCREST DR, GRAYSON, GA 30017-4280
(678) 834-3828
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/17/2026
Last updated
02/17/2026
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