Healthcare Provider Details

I. General information

NPI: 1093638009
Provider Name (Legal Business Name): LEGACY HEALTH & INJURY PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 LASSITER RD STE 100
MARIETTA GA
30062-8332
US

IV. Provider business mailing address

2820 LASSITER RD STE 100
MARIETTA GA
30062-8332
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-3186
  • Fax: 678-579-5775
Mailing address:
  • Phone: 770-559-3186
  • Fax: 678-579-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NAKIA HOLLIDAY
Title or Position: MANAGER
Credential:
Phone: 770-559-3186