Organization
TMC TALLAPOOSA FAMILY HEALTHCARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINT HOFFMAN (SR VP)
(770) 838-8845
Entity
Organization
Contact information
Practice address
25 W LYON ST, TALLAPOOSA, GA 30176-1288
(770) 824-2800
(770) 824-2810
Mailing address
100 GREENWAY BLVD FL 2, CARROLLTON, GA 30117-4338
(770) 838-8710
(770) 812-5735
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
367607289B
CLINIC RENDERING NUMBER
GA
05
—
540960632A
—
GA
01
—
CH7677
MEDICARE ID
GA
Enumeration date
07/30/2006
Last updated
02/29/2024
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