Healthcare Provider Details

I. General information

NPI: 1578238291
Provider Name (Legal Business Name): LEGACY CARE STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 MEMORIAL DR SE STE D
ATLANTA GA
30317-3517
US

IV. Provider business mailing address

3024 MEMORIAL DR SE STE D
ATLANTA GA
30317-3517
US

V. Phone/Fax

Practice location:
  • Phone: 404-795-1455
  • Fax: 866-654-6692
Mailing address:
  • Phone: 404-795-1455
  • Fax: 866-654-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIAWON DOWLING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 678-698-0112