MEDICARE: TMC BUCHANAN FAMILY HEALTHCARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	024466	GA
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1508801416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC BUCHANAN FAMILY HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	100 GREENWAY BLVD FL 2
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4338
Country	:	US
Telephone Number	:	770-838-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 BUSINESS 27
Second Line	:
City	:	BUCHANAN
State	:	GA
Zip	:	30113-4857
Country	:	US
Telephone Number	:	770-646-8281
Fax Number	:	770-646-3579

Authorized Official
Title or Position	:	SR VP
Name	:	CLINT HOFFMAN
Credential	:
Telephone Number	:	770-812-8845

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	02/29/2024

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