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General NPI Number Information
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NPI Number | 1831902550
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Entity Type | Organization
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Legal Business Name | KMS LEGACY, LLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2770 FREEDOM PARKWAY DR STE 2
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-3230
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Country | US
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Telephone | 910-728-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 8132 FAYETTEVILLE RD
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City | RAEFORD
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State | NC
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Zip | 28376-5973
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Country | US
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Telephone | 910-248-6498
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. FREDA L SINGLETARY
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Credential | MD
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Telephone | 910-248-6498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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