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General NPI Number Information
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NPI Number | 1467826933
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Entity Type | Organization
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Legal Business Name | TLC LIFESTYLE COMPANY
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Dates
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Enumeration Date | 11/21/2015
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 3390 PEACHTREE RD NE SUITE 515
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City | ATLANTA
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State | GA
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Zip | 30326-1157
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Country | US
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Telephone | 404-855-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 PEACHTREE RD NE SUITE 520-553
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City | ATLANTA
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State | GA
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Zip | 30326-3287
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YA ALEXANDRA
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Credential |
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Telephone | 404-474-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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