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General NPI Number Information
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NPI Number | 1386048742
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Entity Type | Organization
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Legal Business Name | TLC OF GEORGIA LLC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 3600 DALLAS HWY SW
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City | MARIETTA
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State | GA
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Zip | 30064-1675
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Country | US
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Telephone | 770-420-9170
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 ELM HILL PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3108
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Country | US
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Telephone | 615-425-4200
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | MARC R WATKINS
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Credential |
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Telephone | 615-425-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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