Organization
BOLD LEGACY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEIA M DAWSON DO (MEDICAL DIRECTOR)
(470) 795-0047
Entity
Organization
Contact information
Practice address
1401 JOHNSON FERRY RD STE 390, MARIETTA, GA 30062-9100
(470) 795-0047
Mailing address
1117 EAGLES CREEK WAY NW, ACWORTH, GA 30101-4696
(205) 907-5342
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
12/28/2023
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