Provider Demographics
NPI:1083942650
Name:TLC FOR WOMEN AFTER HOURS L.L.C
Entity Type:Organization
Organization Name:TLC FOR WOMEN AFTER HOURS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:770-995-9100
Mailing Address - Street 1:2069 TERON TRCE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1665
Mailing Address - Country:US
Mailing Address - Phone:770-995-9100
Mailing Address - Fax:770-822-9444
Practice Address - Street 1:2069 TERON TRCE
Practice Address - Street 2:SUITE 100
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1665
Practice Address - Country:US
Practice Address - Phone:770-995-9100
Practice Address - Fax:770-822-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043436207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF73020Medicare UPIN
GA16BBBWLMedicare PIN