PROACTIVE MD GA LLC NPI 1265035877

NPI Information

  • NPI: 1265035877
  • Provider Name: PROACTIVE MD GA, LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Doing Business As: TINDALL CONLEY HEALTH CENTER
  • CLIA Number: 11D2201670
  • Address: 3361 GRANT RD
    CONLEY, GA
    ZIP 30288
  • Phone: (678) 244-7933

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NPI Details

PROACTIVE MD GA, LLC is a primary care clinic center in Conley, GA. PROACTIVE MD GA, LLC NPI is 1265035877. The provider is registered as an organization entity type.
The provider Is Doing Business As Tindall Conley Health Center.

The provider's business location address is:

3361 GRANT RD
CONLEY, GA
ZIP 30288-133
Phone: (678) 244-7933

The provider's authorized official is Jan Hopkins .
The authorized official title is Assoc. Operations Manager and has the following contact phone number (864) 501-0751.

The CLIA number assigned to this NPI record is 11D2201670 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/17/2020 and was last updated on 2/23/2023.

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
1261QP2300XClinic/CenterPrimary CareYes

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: 11/21/2025

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