Provider Demographics
NPI:1962820845
Name:MODERN EMERGENT CARE, LLC
Entity Type:Organization
Organization Name:MODERN EMERGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-557-4220
Mailing Address - Street 1:5505 ROSWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1985
Mailing Address - Country:US
Mailing Address - Phone:404-334-3000
Mailing Address - Fax:478-333-6117
Practice Address - Street 1:5505 ROSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1985
Practice Address - Country:US
Practice Address - Phone:404-334-3000
Practice Address - Fax:478-333-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care