Organization
LEGACY HEALTH AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONNETTE FRANK RN (CHIEF COMPLIANCE OFFICER)
(770) 731-7700
Entity
Organization
Contact information
Practice address
1775 PARKER RD SE STE 210, CONYERS, GA 30094-6654
(707) 731-7700
Mailing address
1775 PARKER RD SE STE 210, CONYERS, GA 30094-6654
(707) 731-7700
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
163WG0000X
General Practice Registered Nurse
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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