Provider Demographics
NPI:1821393380
Name:TIFTON ADDICTION ASSOCIATES, LLC. D/B/A TLC CLINIC
Entity Type:Organization
Organization Name:TIFTON ADDICTION ASSOCIATES, LLC. D/B/A TLC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-382-7898
Mailing Address - Street 1:2402 TIFT AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1885
Mailing Address - Country:US
Mailing Address - Phone:229-382-7898
Mailing Address - Fax:
Practice Address - Street 1:2402 NORTH TIFT AVE SUITE 202
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-382-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHOP0000451835P1200X
GANTP001047207QA0401X, 2084A0401X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty