TLC OF GEORGIA LLC NPI 1124407440

NPI Information

NPI: 1124407440
Provider Name: TLC OF GEORGIA LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 11D2093572

Address:
774 GA HIGHWAY 96
BONAIRE, GA
ZIP 31005
Phone: (478) 988-5711
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TLC OF GEORGIA LLC is a family nurse practitioner in Bonaire, GA. TLC OF GEORGIA LLC NPI is 1124407440. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

774 GA HIGHWAY 96
BONAIRE, GA
ZIP 31005-300
Phone: (478) 988-5711

The provider's authorized official is Marc R Watkins .
The authorized official title is Chief Medical Officer and has the following contact phone number (615) 425-4200.

The CLIA number assigned to this NPI record is 11D2093572 - other - walk-in health care with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/19/2015 and was last updated on 12/21/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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