Legacy Physiatry Group Georgia, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

LEGACY PHYSIATRY GROUP GEORGIA, LLC

Doing business as

Legacy Physiatry Group

Practice address

303 Perimeter Ctr N
Ste 300
Atlanta, GA 30346-3402

Phone

(678) 502-1052

NPI assigned

Apr 23, 2015

Organization subpart

No

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

Authorized official

Name

Vivek Sastry, DO

Title

President/Ceo

Phone

(972) 372-1663

Specialties & licenses 4

Addresses

Other names 1

• Legacy Physiatry Group Doing business as

Locations

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1932596202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 CENTRAL PKWY E",
            "address_2": "SUITE 275",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750745561",
            "telephone_number": "972-372-1663",
            "fax_number": "972-372-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 PERIMETER CTR N",
            "address_2": "STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303463402",
            "telephone_number": "678-502-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHYSIATRY GROUP GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "SASTRY",
        "authorized_official_first_name": "VIVEK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "972-372-1663",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Physiatry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Medicine & Rehabilitation Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physical Medicine & Rehabilitation Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; 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.