NPIMap

Organization Active NPI

Modern Internal Medicine Urgent Care and Primary Care Inc

  • Primary Care Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1528612694
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
MODERN INTERNAL MEDICINE URGENT CARE AND PRIMARY CARE INC
Practice address
2457 Martin Luther King Jr, Dr, SW
Suit a
Atlanta, GA 30311
Phone
(704) 858-6851
NPI assigned
Jul 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Mrs. Hannah QuarshieNPI 1598222895
Title
NP
Phone
(704) 858-6851

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
Urgent Care Clinic/Center 261QU0200X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

2457 Martin Luther King Jr, Dr, SW
Suit a
Atlanta, GA 30311

Mailing address

2363 Timberbrook Trce
Marietta, GA 30066
Phone (704) 858-6851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190828002666 GA Part B Supplier - Clinic/Group Practice 9436487469 Receives reassigned benefits from 2 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

2457 Mlk Jr Dr SW
Atlanta, GA 30311
Phone (206) 452-2091

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21463/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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": "1564185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1528612694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2363 TIMBERBROOK TRCE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30066",
            "telephone_number": "704-858-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2457 MARTIN LUTHER KING JR, DR, SW",
            "address_2": "SUIT A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30311",
            "telephone_number": "704-858-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN INTERNAL MEDICINE URGENT CARE AND PRIMARY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-27",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "QUARSHIE",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "704-858-6851",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.