Provider Demographics
NPI:1811924251
Name:TMC INFECTIOUS DISEASES OF WEST GEORGIA
Entity type:Organization
Organization Name:TMC INFECTIOUS DISEASES OF WEST GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEBBI
Authorized Official - Middle Name:
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:AUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-836-9250
Mailing Address - Fax:770-836-9261
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:C/O ICU
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-836-9666
Practice Address - Fax:770-838-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADG2920OtherMEDICARE ID
GA=========OtherTAX IDENTIFICATION
GA=========OtherTAX IDENTIFICATION