Healthcare Provider Details

I. General information

NPI: 1396662979
Provider Name (Legal Business Name): LEGEND MOBILE NOTARY SERVICES, DBA LEGEND DIAGNOSTICS & TESTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PENNSYLVANIA AVE STE 103
MCDONOUGH GA
30253-9128
US

IV. Provider business mailing address

1700 PENNSYLVANIA AVE STE 103
MCDONOUGH GA
30253-9128
US

V. Phone/Fax

Practice location:
  • Phone: 470-399-1217
  • Fax: 470-993-1211
Mailing address:
  • Phone: 470-399-1217
  • Fax: 470-993-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AUDREY MOORE
Title or Position: OWNER
Credential:
Phone: 470-399-1217