Healthcare Provider Details

I. General information

NPI: 1366388571
Provider Name (Legal Business Name): MODERN MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W BELMONT DR STE 4
CALHOUN GA
30701-3064
US

IV. Provider business mailing address

136 W BELMONT DR STE 4
CALHOUN GA
30701-3064
US

V. Phone/Fax

Practice location:
  • Phone: 706-659-2122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF GETBEHEAD
Title or Position: MANAGER
Credential:
Phone: 504-473-0636