Provider Demographics
NPI:1063184737
Name:MODIFY HEALTH INC
Entity type:Organization
Organization Name:MODIFY HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-519-5503
Mailing Address - Street 1:190 BLUEGRASS VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2204
Mailing Address - Country:US
Mailing Address - Phone:888-766-3439
Mailing Address - Fax:
Practice Address - Street 1:190 BLUEGRASS VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2204
Practice Address - Country:US
Practice Address - Phone:888-766-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No174200000XOther Service ProvidersMealsGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered Meals