Healthcare Provider Details

I. General information

NPI: 1417865023
Provider Name (Legal Business Name): ANATOLIA LEGASPI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9249 HIGHWAY 29 S
ATHENS GA
30601-6352
US

IV. Provider business mailing address

1285 ROSEWOOD DR
ALPHARETTA GA
30005-8322
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035848
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: