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General NPI Number Information
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NPI Number | 1366388571
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Entity Type | Organization
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Legal Business Name | MODERN MEDICAL, LLC
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Dates
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Enumeration Date | 04/28/2026
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Last Update Date | 04/28/2026
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Provider Practice Location Address
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Address Line | 136 W BELMONT DR STE 4
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City | CALHOUN
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State | GA
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Zip | 30701-3064
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Country | US
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Telephone | 706-659-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 136 W BELMONT DR STE 4
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City | CALHOUN
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State | GA
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Zip | 30701-3064
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JEFF GETBEHEAD
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Credential |
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Telephone | 504-473-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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