Provider Demographics
NPI:1750677241
Name:TLC OF GEORGIA LLC
Entity type:Organization
Organization Name:TLC OF GEORGIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-425-4200
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:1685 OLD PENDERGRASS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2705
Practice Address - Country:US
Practice Address - Phone:706-387-7637
Practice Address - Fax:706-387-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176618AMedicaid
GA003152673AMedicaid
GA003158723AMedicaid
GA003159771AMedicaid
GA003181344AMedicaid
GA003152667AMedicaid
GA003215523AMedicaid
GA003162917AMedicaid
GA003182733AMedicaid
GA003151842AMedicaid
GA003181503AMedicaid
GA003152671AMedicaid
GA003152675AMedicaid
GA003162918AMedicaid
GA003152677AMedicaid
GA003152679AMedicaid
GA003156403AMedicaid
GA003161926AMedicaid