TLC OF GEORGIA LLC NPI 1376095638

NPI Information

NPI: 1376095638
Provider Name: TLC OF GEORGIA LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 11D2099824

Address:
564 CROSSTOWN DR
PEACHTREE CITY, GA
ZIP 30269
Phone: (770) 282-2944
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TLC OF GEORGIA LLC is a family nurse practitioner in Peachtree City, GA. TLC OF GEORGIA LLC NPI is 1376095638. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

564 CROSSTOWN DR
PEACHTREE CITY, GA
ZIP 30269-916
Phone: (770) 282-2944
Fax: (770) 282-2945

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

The CLIA number assigned to this NPI record is 11D2099824 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/2/2016 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

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1750677241	OTHER	GEORGIA	GROUP NPI
2	202G701936	MEDICARE PIN	GEORGIA

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: 11/14/2023

NPI Synchronization or Removal

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