MEDICARE: LEGACY HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	044-R-0857	GA

General Provider Information

NPI Number	:	1841583168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	303 PERIMETER CTR N
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30346-3402
Country	:	US
Telephone Number	:	770-457-4938
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 PERIMETER CTR N
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30346-3402
Country	:	US
Telephone Number	:	770-457-4938
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, OPERATIONS
Name	:	REGINALD T. JAMES
Credential	:
Telephone Number	:	310-339-2298

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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