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Organization
TMC CHILDREN'S HEALTHCARE OF WEST GEORGIA
Active
Organization
TMC CHILDREN'S HEALTHCARE OF WEST GEORGIA
Active
Other names
Children's Healthcare of West Georgia
Organization subpart
No
Provider details
NPI number
Authorized official
DALE DREILING M.D. (SENIOR VP)
(770) 838-8038
Entity
Organization
Contact information
Practice address
148 CLINIC AVE, CARROLLTON, GA 30117-4414
(770) 838-8640
(770) 838-8650
Mailing address
148 CLINIC AVE, CARROLLTON, GA 30117-4414
(770) 838-8640
(770) 838-8650
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300035885A
MEDICAID PAYEE
GA
01
—
300035885B
MEDICAID PAYEE
GA
01
—
300035885C
MEDICAID PAYEE
GA
Enumeration date
07/30/2006
Last updated
06/30/2010
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