1083942650 NPI number — TLC FOR WOMEN AFTER HOURS L.L.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083942650 NPI number — TLC FOR WOMEN AFTER HOURS L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC FOR WOMEN AFTER HOURS L.L.C
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:
Provider Other Organization Name Type Code:
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:
1083942650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2069 TERON TRCE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DACULA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30019-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-995-9100
Provider Business Mailing Address Fax Number:
770-822-9444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2069 TERON TRCE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DACULA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30019-1665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-995-9100
Provider Business Practice Location Address Fax Number:
770-822-9444
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MOULTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-995-9100

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  043436 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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