Legacy Physician Consultants, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LEGACY PHYSICIAN CONSULTANTS, LLC

Practice address

209 Peach Orchard Rd
Baldwin, GA 30511-1803

Phone

(706) 713-1904

NPI assigned

May 20, 2024

Last updated

May 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael William Myers

Title

Coo

Phone

(706) 502-0503

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 7

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.

• Pramod Kakarala, M.D.

  • Hospitalist Physician
  • Atlanta, GA
  • NPI 1972881795

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Marie Josette Leblanc-Riley, NP-C

  • Family Nurse Practitioner
  • Athens, GA
  • NPI 1790145563
  Medicare reassignment Care Compare group NPD
• Dipal N Patel, MD

  • Internal Medicine Physician
  • Athens, GA
  • NPI 1922568203
  Medicare reassignment Care Compare group NPD
• Anthony David Sagel, MD

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1871530303
  Medicare reassignment Care Compare group NPD
• Arpit Shah, MD

  • Hospitalist Physician
  • Athens, GA
  • NPI 1083844518

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Gregory Wilkerson, AGACNP-BC

  • Nurse Practitioner
  • Lawrenceville, GA
  • NPI 1053950246
  Medicare reassignment NPD
• Linda Dzifa Idun, MD

  • Hospitalist Physician
  • Xenia, OH
  • NPI 1609047844

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1508605668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 FOREST RD",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306053823",
            "telephone_number": "706-502-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 PEACH ORCHARD RD",
            "city": "BALDWIN",
            "state": "GA",
            "postal_code": "305111803",
            "telephone_number": "706-713-1904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "960 Hawthorne Ave",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306062140",
            "country_code": "US",
            "telephone_number": "706-713-1904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "633 Falls Rd",
            "address_purpose": "LOCATION",
            "city": "Toccoa",
            "state": "GA",
            "postal_code": "305771607",
            "country_code": "US",
            "telephone_number": "706-713-1904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGACY PHYSICIAN CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "706-502-0503"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Brown Gilbert III, M.D.
• Cheryl Glover
• Christopher Ryan Gurley, PHARM D
• Habersham Retreat, Inc
• John Keith Kleinert, O.D.
• Carl Douglas Little Jr., D.C.
• Nomora Corp (The Medicine Shoppe #1497)
• Shayna Patton
• Marina Petrenko, PHARMACIST
• Premise Health of Georgia Medical PC (Fieldale Farms Family Medical Center)

• Internal Medicine Physician in Baldwin, GA
• Providers in Baldwin, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.