Legacy Healthcare Services, Inc.
Organization Active NPI Physical Therapist · Winder, GA
NPI 1831619337 · NPPES record last updated Nov 19, 2024
Key facts
- NPI
- 1831619337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- LEGACY HEALTHCARE SERVICES, INC.
- Practice address
- 901 Haymon Morris Rd
Winder, GA 30680-7837 - Phone
- (678) 705-2123
- NPI assigned
- Jun 26, 2017
- Organization subpart
- No
Authorized official
- Name
- William G. Wilson Jr.
- Title
- Cfo
- Phone
- (919) 424-5080
Practitioners 65
-
Maya Barcelli, OTR/L
-
Deanna Brubaker, PT
-
Courtney Cohen Chambless, PT, DPT
-
Andrea E Dobosz, OTR/L
-
Juliet Trehy Doyal, M. ED
-
Mark Candler Doyal, CCC-SLP
-
Taylor M Fox, PT
-
Joshua James Ghavidel, PT, DPT
-
Susanna Grace Krouse, DPT
-
Nikeesha Lord, OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Windsor Point Inc CCRC |
Skilled nursing facility | Adp of the SNF | Jul 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170912002360 | GA | Part a Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 2163339722 | Practice locations: Alpharetta, GA; Atlanta, GA; Bogart, GA; Johns Creek, GA; Winder, GA; Smyrna, GA |
| O20220916001457 | GA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 2163339722 |
Receives reassigned benefits from 60 practitioners Practice locations: Buford, GA; Roswell, GA; Marietta, GA; Johns Creek, GA; Canton, GA; Atlanta, GA |
National Provider Directory
Locations
12050 Findley Rd
Johns Creek, GA 30097
Phone (404) 383-1129
901 Haymon Morris Rd
Winder, GA 30680
Phone (678) 705-2123
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
901 Haymon Morris Rd
Winder, GA 30680-7837
Mailing address
110 Horizon Dr Ste 310
Raleigh, NC 27615-4926
Phone (919) 424-5080
Other providers in Winder, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.