Healthcare Provider Details

I. General information

NPI: 1861158768
Provider Name (Legal Business Name): LEGACY HOSPICE GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 JUNIPER CT STE 102
BRUNSWICK GA
31520-1952
US

IV. Provider business mailing address

101 W RENNER RD STE 420
RICHARDSON TX
75082-2022
US

V. Phone/Fax

Practice location:
  • Phone: 912-434-9810
  • Fax: 912-434-9752
Mailing address:
  • Phone: 877-525-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONNIE MABERRY
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 877-525-3338