Provider Demographics
NPI:1891185815
Name:MODI, DHRUV KAMLESHKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:DHRUV
Middle Name:KAMLESHKUMAR
Last Name:MODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW STE 290
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1700
Mailing Address - Country:US
Mailing Address - Phone:404-352-3300
Mailing Address - Fax:
Practice Address - Street 1:1267 HIGHWAY 54 W STE 5400
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2113
Practice Address - Country:US
Practice Address - Phone:678-817-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130877207R00000X
OH35.129169208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFM6172136OtherDEA