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
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/14/2024
Last updated
02/14/2024
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