NPIMap

Organization Active NPI

Mishari Primary Care and Aesthetics LLC

  • Primary Care Clinic/Center
  • Grayson, GA
National Provider Identifier
1164375549
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MISHARI PRIMARY CARE AND AESTHETICS LLC
Practice address
2704 Haynescrest Dr
Grayson, GA 30017-4280
Phone
(678) 834-3828
NPI assigned
Feb 17, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anastacia P Modo, FNP-CNPI 1831692110
Title
Owner
Phone
(678) 834-3828

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

2704 Haynescrest Dr
Grayson, GA 30017-4280

Mailing address

2704 Haynescrest Dr
Grayson, GA 30017-4280
Phone (678) 834-3828

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771286400000",
    "number": "1164375549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 HAYNESCREST DR",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300174280",
            "telephone_number": "678-834-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 HAYNESCREST DR",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300174280",
            "telephone_number": "678-834-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISHARI PRIMARY CARE AND AESTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-17",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A",
        "authorized_official_last_name": "MODO",
        "authorized_official_first_name": "ANASTACIA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-834-3828",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.