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Organization
LEGACY PHYSIATRY GROUP GEORGIA, LLC
Active
Organization
LEGACY PHYSIATRY GROUP GEORGIA, LLC
Active
Other names
Legacy Physiatry Group
Organization subpart
No
Provider details
NPI number
Authorized official
VIVEK SASTRY DO (PRESIDENT/CEO)
(972) 372-1663
Entity
Organization
Contact information
Practice address
303 PERIMETER CTR N, STE 300, ATLANTA, GA 30346-3402
(678) 502-1052
Mailing address
850 CENTRAL PKWY E, SUITE 275, PLANO, TX 75074-5561
(972) 372-1663
(972) 372-1657
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/23/2015
Last updated
04/23/2015
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