GWENDOLYN MODDRELL MD PC (NPI# 1992911234) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992911234 |
| Entity Type | Organization |
| Organization Name | GWENDOLYN MODDRELL MD PC |
| Practice Address |
247 W Main St # B Swainsboro GA 30401-3163 |
| Practice Telephone | 4782378101 |
| Practice Fax Number | 4782378118 |
| Mailing Telephone | 4782378101 |
| Mailing Fax Number | 4782378118 |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2008-08-12 |
| Authorized Official Name | GWENDOLYN MODDRELL (OWNER) |
| Authorized Official Telephone | 4782378101 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
Behavioral Health & Social Service Providers |
| Street Address |
247 W MAIN ST # B |
| City | SWAINSBORO |
| State | GA |
| Zip Code | 30401-3163 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114589595 | Mandi Marion Wright | Nurse Practitioner | 117 Kight Road, Swainsboro, GA 30401 | 2019-07-05 |
| 1043767544 | Kathy Flakes | Licensed Practical Nurse | 223 N Anderson Drive, Swainsboro, GA 30401 | 2016-09-01 |
| 1023326220 | Family Podiatry Center PC | Podiatrist | 125a Victory Dr, Swainsboro, GA 30401 | 2010-09-22 |
| 1548578123 | United Rehab Inc | Clinic/Center | 856 U S Highway 1 South, Swainsboro, GA 30401 | 2010-09-17 |
| 1386967305 | William Donald Wages Jr. | Physical Therapy Assistant | 114 Victory Drive, Swainsboro, GA 30401 | 2010-03-04 |
| 1487989885 | Jimmy H Maddox | Nurse Practitioner | 117 Kite Road, Swainsboro, GA 30401 | 2009-10-02 |
| 1649319997 | Swainsboro Healthcare PC | Family Medicine | 305 Kite Road, Swainsboro, GA 30401 | 2007-02-05 |
| 1922153543 | Joyce Dianne Spence | Registered Nurse | 223 Anderson Dr N, Swainsboro, GA 30401 | 2007-01-24 |
| 1942355565 | Lucille Sapp | Registered Nurse | 223 N. Anderson Drive, Swainsboro, GA 30401 | 2007-01-24 |
| 1366592388 | Ogeechee Behavioral Health Services | Community/Behavioral Health | 1007 Highway 56 South, Swainsboro, GA 30401 | 2007-01-11 |
| Find all providers in zip 30401 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982813697 | Augusta Area Psychiatric Associates | Psychologist | 1505 Winter St, Bldg C, Augusta, GA 30904-4819 | 2007-05-21 |
| 1508082850 | Elaine L Levin | Psychologist | 3131 E Shadowlawn Ave Ne, Atlanta, GA 30305-2405 | 2007-04-17 |
| 1487059564 | Peachtree Family Psychiatry Clinic | Psychologist | 1776 Peachtree St Nw, Suite 310 North, Atlanta, GA 30309-2307 | 2014-10-30 |
| 1477814242 | A. Benjamin Eubanks, Md, LLC | Psychologist | 2751 Buford Hwy Ne, Suite 204, Atlanta, GA 30324-3207 | 2012-06-07 |
| 1093041584 | Rockdale Psychiatric Associates PC | Psychologist | 1397 Manchester Dr Ne, Conyers, GA 30012-3882 | 2009-10-19 |
| 1467611087 | David William Tascarella | Psychologist | 3975 Roswell Rd Ne, Atlanta, GA 30342-4117 | 2008-06-09 |
| 1578721189 | Insight Psychotherapy & Assessment Services | Psychologist | 1908 Dawson Rd, Albany, GA 31707-3306 | 2008-05-30 |
| 1801054739 | Scott Snyder, M.d., P.C. | Psychologist | 1999 Prince Ave, Athens, GA 30606-6013 | 2008-05-28 |
| 1851511851 | Institute for Behavioral Medicine | Psychologist | 696 Concord Rd Se, Smyrna, GA 30082-2629 | 2007-05-01 |
| City | SWAINSBORO |
| Zip Code | 30401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.