Gwendolyn Moddrell MD PC

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

Legal business name

GWENDOLYN MODDRELL MD PC

Practice address

247 W Main St # B
Swainsboro, GA 30401-3163

Phone

(478) 237-8101

Fax

(478) 237-8118

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Gwendolyn Moddrell, MD

Title

Owner

Phone

(478) 237-8101

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1992911234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 W MAIN ST # B",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013163",
            "telephone_number": "478-237-8101",
            "fax_number": "478-237-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 W MAIN ST # B",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013163",
            "telephone_number": "478-237-8101",
            "fax_number": "478-237-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWENDOLYN MODDRELL MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "MODDRELL",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-237-8101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dehia Graham, LPC
• Mary Ann Green, PMHNP-BC, APRN
• Mary Jo Greenway, NP
• Laura Groth, PMHNP
• Growing Communication, Inc.
• Shawna Marie Harlin-Clifton, LPC
• Jennifer F. Harrison, FNP-C
• Roy Thomas Harry, MD
• Chelsea Hayman, DNP, APRN, FNP-BC
• William Bradford Headley, M.D.

• Prescribing (Medical) Psychologist in Swainsboro, GA
• Providers in Swainsboro, GA by specialty
• Prescribing (Medical) Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; 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.