Organization
GWENDOLYN MODDRELL MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN MODDRELL MD (OWNER)
(478) 237-8101
Entity
Organization
Contact information
Practice address
247 W MAIN ST # B, SWAINSBORO, GA 30401-3163
(478) 237-8101
(478) 237-8118
Mailing address
247 W MAIN ST # B, SWAINSBORO, GA 30401-3163
(478) 237-8101
(478) 237-8118
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
Other
Enumeration date
05/15/2007
Last updated
08/12/2008
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