1467600916 NPI number — TMC WOODLAND FAMILY HEALTHCARE, INC.

Table of content: (NPI 1467600916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467600916 NPI number — TMC WOODLAND FAMILY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMC WOODLAND FAMILY HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOODLAND FAMILY HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467600916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 GREENWAY BLVD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30117-4338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-838-8710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 COUNTY ROAD 64
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
WOODLAND
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36280-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-449-2001
Provider Business Practice Location Address Fax Number:
256-449-2174
Provider Enumeration Date:
09/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
CLINT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
770-838-8845

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD.9389 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105984 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510G700404 . This is a "GROUP PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 125316 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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