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General NPI Number Information
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NPI Number | 1609384767
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Entity Type | Organization
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Legal Business Name | DAVIS LEGACY ENTERPRISES LLC
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 04/08/2018
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Provider Practice Location Address
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Address Line | 4895 CHIMNEY HILL CT
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City | AUSTELL
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State | GA
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Zip | 30106-1765
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Country | US
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Telephone | 678-398-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 VETERANS MEMORIAL HWY SE SUITE 134 # 444
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City | MABLETON
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State | GA
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Zip | 30126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID DAVIS
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Credential |
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Telephone | 404-281-8826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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