MEDICARE: HADASSA LEGRAND FNP

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	363LF0000X	Family Nurse Practitioner	88024	NM
2	363LF0000X	Family Nurse Practitioner	RN288643	GA

General Provider Information

NPI Number	:	1861868358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADASSA LEGRAND FNP

Provider Business Mailing Address
First Line	:	PO BOX 960434
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-0434
Country	:	US
Telephone Number	:	864-608-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 N HENRY BLVD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-3936
Country	:	US
Telephone Number	:	886-682-6983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	03/16/2026

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