Healthcare Provider Details

I. General information

NPI: 1003247859
Provider Name (Legal Business Name): LEGACY WOMEN'S HEALTHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FY RD NE SUITE 215
ATLANTA GA
30342-1631
US

IV. Provider business mailing address

960 JOHNSON FY RD NE SUITE 215
ATLANTA GA
30342-1631
US

V. Phone/Fax

Practice location:
  • Phone: 404-583-1898
  • Fax:
Mailing address:
  • Phone: 404-583-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARYL HONORE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 404-983-2115