Provider Demographics
NPI:1740573070
Name:THC MEDICAL LLC
Entity Type:Organization
Organization Name:THC MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:PROCACCINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-416-9995
Mailing Address - Street 1:6315 SPALDING DR
Mailing Address - Street 2:STE B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4649
Mailing Address - Country:US
Mailing Address - Phone:770-416-9995
Mailing Address - Fax:770-416-9995
Practice Address - Street 1:6315 SPALDING DR
Practice Address - Street 2:STE B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4649
Practice Address - Country:US
Practice Address - Phone:770-416-9995
Practice Address - Fax:770-416-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty