Provider Demographics
NPI:1841228251
Name:MODI, ANNE MCCLUNG (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MCCLUNG
Last Name:MODI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANN
Other - Last Name:MCCLUNG MODI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:BUILDING F, SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5481
Mailing Address - Country:US
Mailing Address - Phone:770-645-5117
Mailing Address - Fax:770-645-5120
Practice Address - Street 1:1140 HAMMOND DR NE
Practice Address - Street 2:BUILDING F, SUITE 6100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-645-9181
Practice Address - Fax:770-645-8455
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN042198367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000885992AMedicaid
P27770Medicare UPIN
GA000885992AMedicaid