# LEGACY PHYSIATRY GROUP GEORGIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Physiatry Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932596202
- **Authorized official:** VIVEK SASTRY DO (PRESIDENT/CEO)
- **Authorized official phone:** (972) 372-1663

## Contact information

- **Practice address:** 303 PERIMETER CTR N, STE 300, ATLANTA, GA 30346-3402
- **Practice address phone:** (678) 502-1052
- **Mailing address:** 850 CENTRAL PKWY E, SUITE 275, PLANO, TX 75074-5561
- **Mailing address phone:** (972) 372-1663
- **Mailing address fax:** (972) 372-1657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 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