Provider Demographics
NPI:1760449672
Name:LEGACY MEDICAL CENTER OF ATLANTA, INC.
Entity Type:Organization
Organization Name:LEGACY MEDICAL CENTER OF ATLANTA, INC.
Other - Org Name:LEGACY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-699-1111
Mailing Address - Street 1:501 FAIRBURN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2012
Mailing Address - Country:US
Mailing Address - Phone:404-699-1111
Mailing Address - Fax:404-505-5361
Practice Address - Street 1:501 FAIRBURN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2012
Practice Address - Country:US
Practice Address - Phone:404-699-1111
Practice Address - Fax:404-505-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital