OrganizationActive
Bold Legacy Practice, LLC
NPI 1962116392 · Clinic/Center · Marietta, GA
Bold Legacy Practice, LLC is a Clinic/Center organization in Marietta, GA (NPI 1962116392).
Provider details
- NPI number
- 1962116392
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Leia Dawson, Medical Director(470) 795-0047
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1401 Johnson Ferry Rd Ste 390
Marietta, GA 30062-9100
Phone: (470) 795-0047
Street-level locationGet directions
Mailing address
1117 Eagles Creek Way Nw
Acworth, GA 30101-4696
Registry dates
- Enumerated
- 2023-01-10
- Last updated
- 2023-12-28
- Certified
- 2023-12-28
Frequently asked questions
- What is Bold Legacy Practice, LLC's NPI number?
- Bold Legacy Practice, LLC's National Provider Identifier (NPI) is 1962116392, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Bold Legacy Practice, LLC?
- Bold Legacy Practice, LLC is classified in the NPPES registry as Clinic/Center (Ambulatory Health Care Facilities).
- Where is Bold Legacy Practice, LLC located?
- Bold Legacy Practice, LLC's practice location on file with NPPES is 1401 Johnson Ferry Rd Ste 390, Marietta, GA 30062-9100.
- What is Bold Legacy Practice, LLC's phone number?
- The practice phone number listed in the NPPES registry for Bold Legacy Practice, LLC is (470) 795-0047.
- Who is the authorized official for Bold Legacy Practice, LLC?
- The authorized official listed on Bold Legacy Practice, LLC's NPPES record is Leia Dawson, Medical Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Bold Legacy Practice, LLC's NPI active?
- Yes — Bold Legacy Practice, LLC's NPI (1962116392) is active in the NPPES registry as of the last update on 2023-12-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.