NPIMap

Organization Active NPI

Legacy Health and Wellness LLC

  • Health Service Clinic/Center
  • Conyers, GA
National Provider Identifier
1467073189
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
LEGACY HEALTH AND WELLNESS LLC
Practice address
1775 Parker Rd SE Ste 210
Conyers, GA 30094-6654
Phone
(707) 731-7700
NPI assigned
May 5, 2020
Last updated
May 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Authorized official

Name
Ronnette Frank, RNNPI 1194346817
Title
Chief Compliance Officer
Phone
(770) 731-7700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC0400X
General Practice Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WG0000X
Community Health Clinic/Center 261QC1500X
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

1775 Parker Rd SE Ste 210
Conyers, GA 30094-6654

Mailing address

1775 Parker Rd SE Ste 210
Conyers, GA 30094-6654
Phone (707) 731-7700

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Conyers Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588636800000",
    "number": "1467073189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 PARKER RD SE STE 210",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946654",
            "telephone_number": "707-731-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 PARKER RD SE STE 210",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946654",
            "telephone_number": "707-731-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-05",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A",
        "authorized_official_last_name": "FRANK",
        "authorized_official_first_name": "RONNETTE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "770-731-7700",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Conyers",
            "affiliation": "N",
            "endpointDescription": "Conyers",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1775 Parker Rd SE Ste 210",
            "city": "Conyers",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300946654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.