Individual
PRATIK MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-1405
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006993
GA
363AM0700X
Medical Physician Assistant
006993
GA
Other
Enumeration date
10/18/2013
Last updated
11/15/2023
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