Individual
ANIL R MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 MEDICAL DR, SUITE 701, LAGRANGE, GA 30240-4130
(706) 882-8971
(706) 882-8991
Mailing address
300 MEDICAL DR, SUITE 701, LAGRANGE, GA 30240-4130
(706) 882-8971
(706) 882-8971
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
048066
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00843873G
—
GA
Enumeration date
06/01/2005
Last updated
05/28/2024
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