Modly, Lori Angeleene

Modly, Lori Angeleene is an individual health care provider with primary practice located at 743 Spring St Ne , Gainesville GA 30501-3715. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Modly, Lori Angeleene can be contacted via phone (770) 535-3611.

Contact Information

Primary practice address
743 Spring St Ne Gainesville GA 30501-3715
Phone: (770) 535-3611
Fax: (770) 535-7092
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X RN201247 Georgia

Profile Details

NPI number 1871860692
LBN Legal business name Modly, Lori Angeleene
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2011
Last updated Feb 28th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871860692 NPPES
Georgia Other 01467542 AMERIGROUP
Georgia Other 643406 AMERIGROUP
Georgia MEDICAID 003116595A AMERIGROUP

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