# TMC CHILDREN'S HEALTHCARE OF WEST GEORGIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Children's Healthcare of West Georgia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518972348
- **Authorized official:** DALE DREILING M.D. (SENIOR VP)
- **Authorized official phone:** (770) 838-8038

## Contact information

- **Practice address:** 148 CLINIC AVE, CARROLLTON, GA 30117-4414
- **Practice address phone:** (770) 838-8640
- **Practice address fax:** (770) 838-8650
- **Mailing address:** 148 CLINIC AVE, CARROLLTON, GA 30117-4414
- **Mailing address phone:** (770) 838-8640
- **Mailing address fax:** (770) 838-8650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 06/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 300035885A | MEDICAID PAYEE | GA |
| 01 | — | 300035885B | MEDICAID PAYEE | GA |
| 01 | — | 300035885C | MEDICAID PAYEE | GA |