Provider Demographics
NPI:1881255289
Name:1LEGACY EMS LLC
Entity type:Organization
Organization Name:1LEGACY EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:404-509-6711
Mailing Address - Street 1:680 ESTATE CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5557
Mailing Address - Country:US
Mailing Address - Phone:404-509-6711
Mailing Address - Fax:
Practice Address - Street 1:2160 KINGSTON CT SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8951
Practice Address - Country:US
Practice Address - Phone:404-509-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport