Healthcare Provider Details

I. General information

NPI: 1225710890
Provider Name (Legal Business Name): CIMONE LEGENDRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALEXANDER DR
ALPHARETTA GA
30022-3771
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 410
NASHVILLE TN
37217-2665
US

V. Phone/Fax

Practice location:
  • Phone: 855-358-3191
  • Fax:
Mailing address:
  • Phone: 615-696-6316
  • Fax: 615-815-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: