Provider Demographics
NPI:1528612694
Name:MODERN INTERNAL MEDICINE URGENT CARE AND PRIMARY CARE INC
Entity type:Organization
Organization Name:MODERN INTERNAL MEDICINE URGENT CARE AND PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARSHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-858-6851
Mailing Address - Street 1:2363 TIMBERBROOK TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:704-858-6851
Mailing Address - Fax:
Practice Address - Street 1:2457 MARTIN LUTHER KING JR, DR, SW
Practice Address - Street 2:SUIT A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:704-858-6851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-27
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care