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Organization

LISA PREVENTION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. VIKASH CHIRAAG MODI MD (MEDICAL DIRECTOR)
(404) 918-6632
Entity
Organization

Contact information

Practice address
2021 PEACHTREE STREET, SUITE 100, ATLANTA, GA 30309
(404) 918-6632
(833) 488-1894
Mailing address
2021 PEACHTREE STREET, SUITE 100, ATLANTA, GA 30309
(404) 918-6632
(833) 488-1894

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Enumeration date
05/17/2024
Last updated
05/17/2024
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