| Doctor Name: | MRS. MODESTA S HANLEY |
| NPI Number: | 1215115092 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | RN098782 NP |
| Business Practice Address: | 4030 Lawrenville Hwy Georgia Clinic, Pc Lilburn, GA - 30047 |
| Business Phone Number: | 7709214811 |
| Business Fax Number: | |
| Mailing Address: | 526 Trailside Way, STONE MTN |
| State: | GA |
| Postal Code: | 300875448 |
| Phone Number: | 7704697487 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2008 |
| NPI Last Update Date: | 02/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN098782 NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |