Healthcare Provider Details

I. General information

NPI: 1437070893
Provider Name (Legal Business Name): LEGACY WOMEN'S HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N MAIN ST
FOUNTAIN INN SC
29644-1928
US

IV. Provider business mailing address

105 N MAIN ST
FOUNTAIN INN SC
29644-1928
US

V. Phone/Fax

Practice location:
  • Phone: 864-209-1540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: GRACE HANNON
Title or Position: RN
Credential:
Phone: 864-209-1540