Provider Demographics
NPI:1992392344
Name:MCDOWELL LEGACY CORPORATION
Entity Type:Organization
Organization Name:MCDOWELL LEGACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-576-0053
Mailing Address - Street 1:1153 TERRASOL RDG SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3093
Mailing Address - Country:US
Mailing Address - Phone:404-576-0053
Mailing Address - Fax:
Practice Address - Street 1:3635 SAVANNAH PL STE 450-B
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6341
Practice Address - Country:US
Practice Address - Phone:470-508-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory