Healthcare Provider Details

I. General information

NPI: 1679055511
Provider Name (Legal Business Name): LEGACY HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 WHEELER RD
AUGUSTA GA
30909-6623
US

IV. Provider business mailing address

3001 SPRING FOREST RD STE 101
RALEIGH NC
27616-2816
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-3325
  • Fax:
Mailing address:
  • Phone: 919-424-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA M HOSKINS
Title or Position: CEO
Credential:
Phone: 919-424-5080