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ANZOR MODZGVRESCHVILI RD
NPI 1245866862
Dietitian, Registered - Nutrition, Gerontological in Detroit, MI

Active since March 15, 2020
15750 JOY RD, DETROIT, MI 48228(313) 273-6850 Get Directions Write a Review

NPPES record last updated: September 20, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 20, 2022, Mar 15, 2020 (2 updates tracked since 2020).

About Anzor Modzgvreschvili Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANZOR MODZGVRESCHVILI RD (NPI 1245866862) is an individual nutrition, gerontological provider in Detroit, Michigan, licensed in Maryland (C05672) and active in the NPI registry since March 2020. He maintains a secondary practice location in Bethesda.

NPPES Registry Identity

NPI1245866862
Entity TypeIndividualMale
Primary Taxonomy133VN1101X
Provider Legal NameANZOR MODZGVRESCHVILICredential: RD
Location Address15750 JOY RDDetroit, MI 48228-2196
Mailing Address6201 Greenleigh AveMiddle River, MD 21220-2004
Phone(313) 273-6850
Sole ProprietorNo
Enumeration DateMarch 15, 2020
Last NPPES UpdateSeptember 20, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 20, 2022
✔ NPI 1245866862 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, Registered · Nutrition, GerontologicalDietary & Nutritional Service Providers
Taxonomy Code133VN1101X
License✔ Licensed in MD · C05672
Definition
An individual who is a Specialist in Gerontological Nutrition and provides nutrition care to promote quality of life and optimal health for older adults across the continuum of care, including: acute care, post-acute care, primary care, long-term care, assisted living, home care, palliative care, community-based nutrition, food service, correctional facilities, and government programs. RDN who works indirectly with gerontological nutrition through roles in management, industry, education, and research.
15750 JOY RD, Detroit, MI 48228
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Secondary Practice Location 1

Location 18600 Old Georgetown RdBethesda, MD 20814-1422 · Phone (301) 896-2578

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JANET LANG
Occupational Therapist (Physical Rehabilitation)
15750 JOY RD
DETROIT, MI 48228
Wayne County (313) 273-6850
FAIRLANE SENIOR CARE AND REHAB CENTER, LLC
Skilled Nursing Facility
15750 JOY RD
DETROIT, MI 48228
Wayne County (313) 273-6850
JAVID M KHAN PHYSICAL THERAPIST
Physical Therapist
15750 JOY RD
DETROIT, MI 48228
Wayne County (313) 273-6850

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Anzor Modzgvreschvili's NPI number?

The NPI number for Anzor Modzgvreschvili is 1245866862. It was assigned to this individual provider in the NPPES registry on March 15, 2020.

Where is Anzor Modzgvreschvili located?

Anzor Modzgvreschvili practices at 15750 Joy Rd, Detroit, MI 48228. The listed phone number is (313) 273-6850.

What is Anzor Modzgvreschvili's specialty?

The primary specialty registered for this NPI is Dietitian, Registered, specializing in Nutrition, Gerontological, with taxonomy code 133VN1101X.

When was this NPI record last updated?

The NPPES record for Anzor Modzgvreschvili was last updated on September 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.