Legacy Healthcare Services Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LEGACY HEALTHCARE SERVICES INC

Practice address

940 S Enota Dr NE
Gainesville, GA 30501-2451

Phone

(678) 971-1377

NPI assigned

Feb 11, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. William Gil Wilson Jr.

Title

Chief Financial Officer

Phone

(919) 424-5080

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 116912

Legal name

LEGACY HEALTHCARE SERVICES, INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Aug 23, 2021

Last certification

Aug 7, 2024

Ownership / control type

Voluntary Non-Profit Other Than Church

Facility address

940 South Enota Drive NE
Gainesville, GA 30501

Tax ID family

Legacy61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 4

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Legacy Healthcare Services Inc

  • Physical Therapist
  • Rome, GA
  • NPI 1558938159
  NPD tax ID
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Augusta, GA
  • NPI 1679055511
  NPD tax ID
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Palmetto, GA
  • NPI 1942842919
  NPD tax ID
• Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Dawsonville, GA
  • NPI 1528419751
  NPD tax ID

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1376135293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 SPRING FOREST RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162815",
            "telephone_number": "910-724-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 S ENOTA DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012451",
            "telephone_number": "678-971-1377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GIL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "919-424-5080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Lee Leech, ACNP-BC
• Jacob Leedekerken
• Ryan Leeson, MD
• Heneicia Leflore, PA-C
• Legacy Family Dentistry, P.C.
• Legacy Heart Care of Gainesville, LLC
• Legacy Link, Inc
• Molly Legg, PT
• Jason Aaron Lemons, M.D.
• Jonathan David Lenz

• Physical Therapist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.