TLC OF GEORGIA LLC NPI 1386193571

NPI Information

NPI: 1386193571
Provider Name: TLC OF GEORGIA LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 11D2113141

Address:
4321 HARTLEY BRIDGE RD
MACON, GA
ZIP 31216
Phone: (478) 788-2046
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TLC OF GEORGIA LLC is a family nurse practitioner in Macon, GA. TLC OF GEORGIA LLC NPI is 1386193571. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4321 HARTLEY BRIDGE RD
MACON, GA
ZIP 31216-641
Phone: (478) 788-2046
Fax: (478) 788-2047

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 11D2113141 - other - walk in health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2016 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	363A00000X	Physician Assistant				No
2	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: 4/28/2024

NPI Synchronization or Removal

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