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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

BOLD LEGACY PRACTICE, LLC

Active Organization

BOLD LEGACY PRACTICE, LLC is a Clinic/Center organization located in MARIETTA, Georgia. NPI 1962116392 is currently active in the NPPES registry. Verify at CMS.

Clinic/Center · MARIETTA, GA

Registration Details

NPI Number
1962116392
Provider Type
Organization
NPI Issued
Jan 10, 2023 (3.6312851327188 yrs)
Last Updated
Dec 28, 2023

Practice Information

Address
1401 JOHNSON FERRY RD STE 390
MARIETTA, GA, 300629100
Browse GA providers · Browse ZIP 30062
Phone
4707950047
Primary Specialty
Clinic/Center
261Q00000X
Data sourced from the NPPES National Provider Identifier registry. Healthcare organizations registered in NPPES are assigned an NPI number for use in insurance billing and claims. This information is for informational purposes only. For official verification, use the NPPES NPI Registry.