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Lori Angeleene Modly, CPNP
Pediatric Nurse Practitioner in Gainesville, Georgia
NPI 1871860692

Lori Angeleene Modly is a Pediatric Nurse Practitioner based in Gainesville, GA and is specialized in Pediatrics. Lori Angeleene Modly practices in Gainesville, GA and has the professional credentials of CPNP. The NPI Number for Lori Angeleene Modly is 1871860692 and holds a License No. RN201247 (Georgia).

The current practice location address for Lori Angeleene Modly is 743 Spring St Ne, Gainesville, GA and can be reached out via phone at 770-535-3611 and via fax at 770-535-7092. You can also correspond with Lori Angeleene Modly through the mailing address at PO BOX 658, GAINESVILLE, GA - 30503-0658 (mailing address contact number: 770-718-1122).

Location: 743 Spring St Ne, Gainesville, GA, 30503-0658
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Provider Profile Details
NPI Number
1871860692
Provider Name
Lori Angeleene Modly
Credential
CPNP
Provider Entity Type
Individual
Gender
Female
Address
743 Spring St Ne, Gainesville, GA, 30503-0658
Phone Number
770-535-3611
Fax Number
770-535-7092
Provider Enumeration Date
11/22/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
01467542 01 GA AMERIGROUP
643406 01 GA WELLCARE
003116595A 05 GA
institution
Provider Business Practice Location Address Details
Address
743 Spring St Ne
City
State
Zip
30501-3715
Phone Number
770-535-3611
Fax Number
770-535-7092
person
Provider Business Mailing Address Details
Address
Po Box 658
City
State
Zip
30503-0658
Phone Number
770-718-1122
Fax Number
770-535-7445
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Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Pediatrics
Taxonomy
License No.
RN201247 (Georgia)
Definition
Definition to come...
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