Provider Demographics
NPI:1780905018
Name:MODI, VIKASH CHIRAAG (MD)
Entity type:Individual
Prefix:DR
First Name:VIKASH
Middle Name:CHIRAAG
Last Name:MODI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2021 PEACHTREE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:833-773-6886
Mailing Address - Fax:833-773-6886
Practice Address - Street 1:2021 PEACHTREE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:833-773-6886
Practice Address - Fax:833-773-6886
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2024-05-09
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Provider Licenses
StateLicense IDTaxonomies
GA702262083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20208I7354Medicare PIN