Provider Demographics
NPI:1386708097
Name:TMC IMMEDIATE CARE, INC
Entity type:Organization
Organization Name:TMC IMMEDIATE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-812-8845
Mailing Address - Street 1:100 GREENWAY BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4338
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-812-5735
Practice Address - Street 1:101 QUARTZ DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3255
Practice Address - Country:US
Practice Address - Phone:770-949-7500
Practice Address - Fax:770-942-8800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANNER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6448Medicare PIN