BOLD LEGACY PRACTICE, LLC
NPI 1962116392
Clinic/Center in Marietta, GA

Q: What is Bold Legacy Practice, LLC's NPI number?

The NPI number for Bold Legacy Practice, LLC is 1962116392. It was assigned to this organization in the NPPES registry on January 10, 2023.

Q: What is Bold Legacy Practice, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since January 10, 2023

1401 JOHNSON FERRY RD STE 390, MARIETTA, GA 30062(470) 795-0047 Get Directions Write a Review

NPPES record last updated: December 28, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Bold Legacy Practice, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOLD LEGACY PRACTICE, LLC (NPI 1962116392) is a healthcare organization registered as a clinic/center in Marietta, Georgia and active in the NPI registry since January 2023. The organization lists Leia M Dawson, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1962116392

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameBOLD LEGACY PRACTICE, LLC

Location Address1401 JOHNSON FERRY RD STE 390Marietta, GA 30062-9100

Mailing Address1117 Eagles Creek Way NwAcworth, GA 30101-4696 · (205) 907-5342

Phone(470) 795-0047

Organization SubpartNo

Authorized OfficialLeia M DawsonMedical Director · (470) 795-0047

Enumeration DateJanuary 10, 2023

Last NPPES UpdateDecember 28, 2023

NPPES CertifiedDecember 28, 2023

✔ NPI 1962116392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

1401 JOHNSON FERRY RD STE 390, Marietta, GA 30062

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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LEIA M DAWSON D.O.

Family Medicine

1401 JOHNSON FERRY RD STE 390
MARIETTA, GA 30062

Cobb County (470) 250-1492

ASHEIA RENEE' MERRITT FNP

Nurse Practitioner (Family)

1401 JOHNSON FERRY RD STE 390
MARIETTA, GA 30062

Cobb County (470) 250-1492

BOLD LEGACY PRACTICE, LLC

Clinic/Center (Urgent Care)

1401 JOHNSON FERRY RD STE 390
MARIETTA, GA 30062

Cobb County (470) 795-0047

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bold Legacy Practice, LLC's NPI number?

The NPI number for Bold Legacy Practice, LLC is 1962116392. It was assigned to this organization in the NPPES registry on January 10, 2023.

Where is Bold Legacy Practice, LLC located?

Bold Legacy Practice, LLC is located at 1401 Johnson Ferry Rd Ste 390, Marietta, GA 30062. The listed phone number is (470) 795-0047.

What is Bold Legacy Practice, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Bold Legacy Practice, LLC was last updated on December 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.