Provider Demographics
NPI:1346406071
Name:TMC INTERNAL MEDICINE OF VILLA RICA, INC.
Entity Type:Organization
Organization Name:TMC INTERNAL MEDICINE OF VILLA RICA, INC.
Other - Org Name:INTERNAL MEDICINE OF VILLA RICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACALUSO-PEARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-838-8554
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1264
Practice Address - Country:US
Practice Address - Phone:770-456-3839
Practice Address - Fax:770-456-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty