LEGACY PRIMARY CARE AND WELLNESS NPI 1508461070

NPI Information

NPI: 1508461070
Provider Name: LEGACY PRIMARY CARE AND WELLNESS

Other Name: LEGACY PRIMARY CARE AND WELLNESS LLC

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
195 UPPER RIVERDALE RD SW STE B
RIVERDALE, GA
ZIP 30274
Phone: (770) 703-8465
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LEGACY PRIMARY CARE AND WELLNESS is a primary care clinic center in Riverdale, GA. LEGACY PRIMARY CARE AND WELLNESS NPI is 1508461070. The provider is registered as an organization entity type.
The provider Other Name Is Legacy Primary Care And Wellness Llc.

The provider's business location address is:

195 UPPER RIVERDALE RD SW STE B
RIVERDALE, GA
ZIP 30274-518
Phone: (770) 703-8465
Fax: (770) 629-2392

The provider's authorized official is Betty Elizabeth Strong .
The authorized official title is Physician/owner and has the following contact phone number (770) 703-8465.

The enumeration date for this NPI number is 12/2/2020 and was last updated on 8/12/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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