Legacy Medical, LLC

NPI #1750846648 in Sugar Hill, Georgia

Provider Information

NPI Number: 1750846648
Entity Type: Organization
Organization Name: Legacy Medical, LLC
Primary Specialty: Internal Medicine
Enumeration Date: Feb 5, 2019
Last Updated: Oct 8, 2022

Practice Location

Address: 5422 CUMMING HWY STE 104
City: Sugar Hill
State: Georgia
ZIP Code: 30518-7027
Phone: (678) 765-7147

Authorized Official

Name: DR. COLETTE DEVONA BULLOCK, DO
Title: CEO
Phone: (678) 765-7147

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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