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1962116392
BOLD LEGACY PRACTICE, LLC
MARIETTA, GA
NPI
1962116392
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Entity Type
Organization
Authorized Contact
LEIA M DAWSON
Medical Director
470-795-0047
Organization Subpart ?
No
Primary Taxonomy
261Q00000X Clinic/Center
Enumeration Date
2023-01-10
Last Update Date
2023-12-28
Business Address
BOLD LEGACY PRACTICE, LLC
1401 JOHNSON FERRY RD STE 390
MARIETTA, GA 30062-9100
Phone number: 470-795-0047
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Mailing Address
BOLD LEGACY PRACTICE, LLC
1117 EAGLES CREEK WAY NW
ACWORTH, GA 30101-4696
Phone number: 205-907-5342
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