Provider Demographics
NPI:1164649356
Name:TLC FAMILY CARE PC
Entity Type:Organization
Organization Name:TLC FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-739-0048
Mailing Address - Street 1:705 HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1008
Mailing Address - Country:US
Mailing Address - Phone:931-739-0048
Mailing Address - Fax:931-739-0047
Practice Address - Street 1:705 HOWELL ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1008
Practice Address - Country:US
Practice Address - Phone:931-739-0048
Practice Address - Fax:931-739-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732621Medicaid
TN3732621Medicaid
TNI08790Medicare UPIN