Healthcare Provider Details

I. General information

NPI: 1750677241
Provider Name (Legal Business Name): TLC OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 OLD PENDERGRASS RD
JEFFERSON GA
30549-2705
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 706-387-7637
  • Fax: 706-387-7638
Mailing address:
  • Phone: 615-425-4200
  • Fax:

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: MR. THOMAS SHELLY
Title or Position: VP & GENERAL MANAGER
Credential:
Phone: 615-425-4200