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:
Health care specialties
| Specialty | Code | License # | 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 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871860692 | NPPES |
| Georgia | Other | 01467542 | AMERIGROUP |
| Georgia | Other | 643406 | AMERIGROUP |
| Georgia | MEDICAID | 003116595A | AMERIGROUP |
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