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NPI Code Detail

MEDICARE: TLC OF GEORGIA LLC

MEDICARE: TLC OF GEORGIA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11750677241OTHERGAGROUP NPI

General Provider Information

NPI Number : 1386193571
Entity Type Code : Organization
Provider Name (Legal Business Name) : TLC OF GEORGIA LLC
Provider Business Mailing Address
First Line : 2620 ELM HILL PIKE
Second Line :
City : NASHVILLE
State : TN
Zip : 37214-3108
Country : US
Telephone Number : 615-425-4200
Fax Number : 615-891-5244
Provider Business Practice Location Address
First Line : 4321 HARTLEY BRIDGE RD
Second Line :
City : MACON
State : GA
Zip : 31216-5641
Country : US
Telephone Number : 478-788-2046
Fax Number : 478-788-2047
Authorized Official
Title or Position : VP & GENERAL MANAGER
Name : THOMAS SHELLY
Credential :
Telephone Number : 615-425-4200
Provider Enumeration Date : 09/28/2016
Last Update Date : 10/22/2025

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Directions to “TLC OF GEORGIA LLC ” Practice Location

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