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General NPI Number Information
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NPI Number | 1033400254
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Entity Type | Organization
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Legal Business Name | LEGACY MEDICAL CARE, LLC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 805 MADISON ST SE SUITE 2B
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4419
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Country | US
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Telephone | 256-533-8408
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Fax | 256-533-8409
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Provider Business Mailing Address
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Address Line | 805 MADISON ST SE SUITE 2B
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4419
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Country | US
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Telephone | 256-533-8408
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Fax | 256-533-8409
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Authorized Official
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Title or Position | PHYSICIAN
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Name | NICOLE D. SCRUGGS
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Credential | MD
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Telephone | 256-533-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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