Organization
BOLD LEGACY PRACTICE, LLC
Active
Other names
American Family Care, Quadrivium Health LLC, Bold Legacy Management, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEIA CHATMAN DAWSON DO (MEDICAL DIRECTOR)
(205) 907-5342
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
(470) 795-0047
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/16/2022
Last updated
01/05/2024
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