# TIFTON ADDICTION ASSOCIATES, LLC. D/B/A TLC CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821393380
- **Authorized official:** JONATHAN PAUL CONNELL (MANAGING MEMBER)
- **Authorized official phone:** (229) 382-7898

## Contact information

- **Practice address:** 2402 NORTH TIFT AVE SUITE 202, TIFTON, GA 31794
- **Practice address phone:** (229) 382-7898
- **Mailing address:** 2402 TIFT AVE N STE 202, TIFTON, GA 31794-1885
- **Mailing address phone:** (229) 382-7898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1835P1200X | Pharmacotherapy Pharmacist | PHOP000045 | GA | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | NTP001047 | GA | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | NTP001047 | GA | Yes |
| 2084P0802X | Addiction Psychiatry Physician | NTP001047 | GA | — |

## Other

- **Enumeration date:** 01/14/2011
- **Last updated:** 01/14/2011