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Organization
LEGACY MEDICAL CLINIC WITH MENTAL HEALTH, LLC
Active
Organization
LEGACY MEDICAL CLINIC WITH MENTAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUKS NWAULU (OWNER)
(240) 422-0687
Entity
Organization
Contact information
Practice address
4700 STAMP RD STE K, TEMPLE HILLS, MD 20748-6717
(301) 880-4900
Mailing address
9509 MANOR OAKS VW, UPPER MARLBORO, MD 20772-3192
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/14/2024
Last updated
02/14/2024
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