Provider Demographics
NPI:1093425563
Name:MODERN HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:MODERN HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. MADGALENE OZIWO
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OZIWO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-DNP
Authorized Official - Phone:678-209-9338
Mailing Address - Street 1:7943 HAWKS NEST TRL
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-7821
Mailing Address - Country:US
Mailing Address - Phone:678-209-9338
Mailing Address - Fax:
Practice Address - Street 1:7943 HAWKS NEST TRL
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-7821
Practice Address - Country:US
Practice Address - Phone:678-209-9338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty