Healthcare Provider Details

I. General information

NPI: 1386193571
Provider Name (Legal Business Name): TLC OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 HARTLEY BRIDGE RD
MACON GA
31216-5641
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 478-788-2046
  • Fax: 478-788-2047
Mailing address:
  • Phone: 615-425-4200
  • Fax: 615-891-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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