NPIMap

Organization Active NPI

Modern Internal Medicine

  • General Practice Physician
  • Atlanta, GA
National Provider Identifier
1982095360
Registry record updated Feb 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MODERN INTERNAL MEDICINE
Practice address
2457 Martin Luther King Jr Dr SW
Suite a
Atlanta, GA 30311-1712
Phone
(404) 368-8655
NPI assigned
Feb 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2015

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

Authorized official

Name
Deandre Green
Title
Ceo
Phone
(404) 368-8655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2457 Martin Luther King Jr Dr SW
Suite a
Atlanta, GA 30311-1712

Mailing address

2457 Martin Luther King Jr Dr SW
Suite a
Atlanta, GA 30311-1712
Phone (404) 368-8655

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1423180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1982095360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2457 MARTIN LUTHER KING JR DR SW",
            "address_2": "SUITE A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303111712",
            "telephone_number": "404-368-8655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2457 MARTIN LUTHER KING JR DR SW",
            "address_2": "SUITE A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303111712",
            "telephone_number": "404-368-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-06",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DEANDRE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-368-8655"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "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 Feb 6, 2015; 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.