Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Legacy Medical Group, PLLC

Organization Internal Medicine Physician · NPI 1558010843

Legacy Medical Group, PLLC is an Internal Medicine Physician in Greensboro, North Carolina. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
4
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

302 Pomona Dr Ste L
Greensboro, NC 27407-1642
Phone: (336) 763-1980
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Home Infusion Agency Taxonomy 251F00000X
Infusion Therapy Clinic/Center Taxonomy 261QI0500X
Primary Care Clinic/Center Taxonomy 261QP2300X

Record details

NPI number1558010843
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tiara Shackleford — Nurse Practitioner · (336) 944-9950
NPI enumeratedMarch 22, 2022
Last updated in NPPESMarch 22, 2022
Certification dateMarch 22, 2022
Mailing address302 Pomona Dr Ste L, Greensboro, NC 27407-1642

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