Provider Demographics
NPI:1760861256
Name:MODY, ROXANNE R (MD)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:R
Last Name:MODY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 DAN PROCTOR DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3895
Mailing Address - Country:US
Mailing Address - Phone:912-540-6750
Mailing Address - Fax:
Practice Address - Street 1:2060 DAN PROCTOR DR STE 1200
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3895
Practice Address - Country:US
Practice Address - Phone:912-540-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97788207V00000X
CO0059821207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology