MEDICARE: TMC INTERNAL MEDICINE ASSOCIATES VILLA RICA

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
1	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH5396	OTHER	GA	MEDICARE ID

General Provider Information

NPI Number	:	1730194457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC INTERNAL MEDICINE ASSOCIATES VILLA RICA

Provider Business Mailing Address
First Line	:	119 AMBULANCE DR
Second Line	:	SUITE 202
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3857
Country	:	US
Telephone Number	:
Fax Number	:	770-836-9261

Provider Business Practice Location Address
First Line	:	690 DALLAS HWY
Second Line	:	SUITE 303
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1209
Country	:	US
Telephone Number	:	770-456-3790
Fax Number	:	770-456-3785

Authorized Official
Title or Position	:	SENIOR VP
Name	:	DALE DREILING
Credential	:	M.D.
Telephone Number	:	770-838-8038

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	06/30/2010

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