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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1912399866
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	:

Provider Business Practice Location Address
First Line	:	1227 ROCKBRIDGE RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-3064
Country	:	US
Telephone Number	:	770-413-1476
Fax Number	:

Authorized Official
Title or Position	:	VP & GENERAL MANAGER
Name	:	THOMAS SHELLY
Credential	:
Telephone Number	:	615-425-4200

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	10/22/2025

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Directions to “TLC OF GEORGIA LLC ” Practice Location

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