Healthcare Provider Details

I. General information

NPI: 1811523137
Provider Name (Legal Business Name): TLC PEDIATRICS & FAMILY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22335 US HIGHWAY 72 STE C SUITE C
ATHENS AL
35613-2611
US

IV. Provider business mailing address

22335 US HIGHWAY 72 STE C SUITE C
ATHENS AL
35613-2611
US

V. Phone/Fax

Practice location:
  • Phone: 256-585-5626
  • Fax: 256-870-4112
Mailing address:
  • Phone: 256-870-4111
  • Fax: 256-870-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TEAIRAH WILDER
Title or Position: OWNER/CRNP
Credential: CRNP
Phone: 256-870-4111