Individual
ANASTACIA P MODO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2496 COLUMBIA DR, DECATUR, GA 30034-1769
(404) 534-9222
(404) 534-9063
Mailing address
2704 HAYNESCREST DR, GRAYSON, GA 30017-4280
(678) 834-3828
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN241610
GA
363LF0000X
Family Nurse Practitioner
241610
GA
Other
Enumeration date
03/13/2018
Last updated
04/22/2026
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