Organization
LEGACY MEDICAL, LLC
Active
Organization
LEGACY MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLETTE DEVONA BULLOCK DO (CEO)
(678) 765-7147
Entity
Organization
Contact information
Practice address
5422 CUMMING HWY STE 104, SUGAR HILL, GA 30518-7027
(678) 765-7147
(877) 991-5350
Mailing address
5422 CUMMING HWY STE 104, SUGAR HILL, GA 30518-7027
(678) 765-7147
(877) 991-5350
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
02/05/2019
Last updated
10/08/2022
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