| Legacy Medical, Llc | |
|
5422 Cumming Hwy Ste 104 Sugar Hill GA 30518-7027 | |
| (678) 765-7147 | |
| (877) 991-5350 |
| Full Name | Legacy Medical, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5422 Cumming Hwy Ste 104, Sugar Hill, Georgia |
| Authorized Official Name and Position | Colette Devona Bullock (CEO) |
| Authorized Official Contact | 6787657147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical, Llc 5422 Cumming Hwy Ste 104 Sugar Hill GA 30518-7027 Ph: (678) 765-7147 | Legacy Medical, Llc 5422 Cumming Hwy Ste 104 Sugar Hill GA 30518-7027 Ph: (678) 765-7147 |
| NPI Number | 1750846648 |
|---|---|
| Provider Enumeration Date | 02/05/2019 |
| Last Update Date | 10/08/2022 |
| Medicare PECOS PAC ID | 9739515404 |
|---|---|
| Medicare Enrollment ID | O20200129001441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750846648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Colette Devona Bullock |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164612370 PECOS PAC ID: 3375722648 Enrollment ID: I20160829000772 |
Medcare General, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 245 Peachtree Industrial Blvd, Suite100, Sugar Hill, GA 30518 Phone: 770-856-8736 | |
Tri County Internal Medicine, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4720 Nelson Brogdon Blvd, Sugar Hill, GA 30518 Phone: 770-945-1990 Fax: 678-745-4139 | |
Gwinnett Family Physicians Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4585 Nelson Brogdon Blvd, Sugar Hill, GA 30518 Phone: 770-932-0547 Fax: 770-932-4035 | |
Suwanahoochee Pediatrics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Peachtree Industrial Blvd Ste A, Sugar Hill, GA 30518 Phone: 678-765-8622 Fax: 678-765-8621 |