Organization
TIFTON ADDICTION ASSOCIATES, LLC. D/B/A TLC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN PAUL CONNELL (MANAGING MEMBER)
(229) 382-7898
Entity
Organization
Contact information
Practice address
2402 NORTH TIFT AVE SUITE 202, TIFTON, GA 31794
(229) 382-7898
Mailing address
2402 TIFT AVE N STE 202, TIFTON, GA 31794-1885
(229) 382-7898
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
PHOP000045
GA
207QA0401X
Addiction Medicine (Family Medicine) Physician
NTP001047
GA
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
NTP001047
GA
2084P0802X
Addiction Psychiatry Physician
NTP001047
GA
Other
Enumeration date
01/14/2011
Last updated
01/14/2011
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