Organization
TLC FOR WOMEN
Active
Other names
Total Lifetime Care for Women
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES RICHARD MOULTON II M.D. (CEO)
(770) 995-9100
Entity
Organization
Contact information
Practice address
555 OLD NORCROSS RD, SUITE 250, LAWRENCEVILLE, GA 30045-8716
(770) 995-9100
(770) 822-9444
Mailing address
2069 TERON TRCE, DACULA, GA 30019-1665
(770) 995-9100
(770) 822-9444
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
043436
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000750362B
—
GA
01
—
0013191
BCBS
GA
01
—
309499
WELLCARE
GA
01
—
4804710
CIGNA
GA
01
—
5554055
AETNA
GA
01
—
P00130132
RR MEDICARE
GA
Enumeration date
06/04/2006
Last updated
09/29/2010
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