Provider Demographics
NPI:1659780005
Name:TLC PRIMARY CARE LLC
Entity Type:Organization
Organization Name:TLC PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-362-7600
Mailing Address - Street 1:9457 DAVID SMITH LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7292
Mailing Address - Country:US
Mailing Address - Phone:423-362-7600
Mailing Address - Fax:423-238-6565
Practice Address - Street 1:9457 DAVID SMITH LN
Practice Address - Street 2:SUITE 105
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7292
Practice Address - Country:US
Practice Address - Phone:423-362-7600
Practice Address - Fax:423-238-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48915174400000X
TNAPN0000005112363LP2300X
TNF0613640363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty