| Bold Legacy Practice, Llc | |
|
1401 Johnson Ferry Rd Ste 390 Marietta GA 30062-9100 | |
| (470) 795-0047 | |
| Not Available |
| Full Name | Bold Legacy Practice, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 1401 Johnson Ferry Rd Ste 390, Marietta, Georgia |
| Authorized Official Name and Position | Leia M Dawson (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4707950047 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bold Legacy Practice, Llc 1117 Eagles Creek Way Nw Acworth GA 30101-4696 Ph: (205) 907-5342 | Bold Legacy Practice, Llc 1401 Johnson Ferry Rd Ste 390 Marietta GA 30062-9100 Ph: (470) 795-0047 |
| NPI Number | 1962116392 |
|---|---|
| Provider Enumeration Date | 01/10/2023 |
| Last Update Date | 12/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962116392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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